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Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study)
  1. L Paccola1,
  2. R A Costa2,
  3. M S Folgosa1,
  4. J C Barbosa3,
  5. I U Scott4,
  6. R Jorge1
  1. 1
    Department of Ophthalmology, School of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil
  2. 2
    UDAT – Macular Imaging & Treatment Division, Hospital de Olhos de Araraquara, Araraquara, SP, Brazil
  3. 3
    Exact Sciences Department, São Paulo State University, Jaboticabal, SP, Brazil
  4. 4
    Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
  1. R Jorge, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Avenida Bandeirantes 3900. Ribeirão Preto-SP 14049-900, Brazil; rjorge{at}


Background/aims: The aim of this study was to compare the morphological and visual acuity outcomes associated with a single intravitreal injection of triamcinolone acetonide versus bevacizumab for the treatment of refractory diffuse diabetic macular oedema.

Methods: Twenty-eight patients were randomly assigned to receive a single intravitreal injection of either 4 mg/0.1 ml triamcinolone acetonide or 1.5 mg/0.06 ml bevacizumab. Comprehensive ophthalmic evaluation was performed at baseline and at weeks 1, 4, 8 (±1), 12 (±2) and 24 (±2) after treatment. Main outcome measures included central macular thickness measured with optical coherence tomography (OCT) and best corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity.

Results: Twenty-six patients (26 eyes) completed all study visits (two patients missed two consecutive study visits). Central macular thickness was significantly reduced in the intravitreal triamcinolone group compared with the bevacizumab group at weeks 4, 8, 12 and 24 (p<0.05). Logarithm of the minimum angle of resolution (LogMAR) best-corrected visual acuity was significantly higher at weeks 8 (0.69; ∼20/100+1) and 12 (0.74; 20/100−2) in the intravitreal triamcinolone group compared with the bevacizumab group (weeks 8 (0.83; ∼20/125−1) and 12 (0.86; 20/160+2)) (p<0.05). Significant change from baseline in mean intraocular pressure (mmHg) was seen at week 4 (+2.25) only in the intravitreal triamcinolone group (p<0.0001). No patient had observed cataract progression during the study.

Conclusions: One single intravitreal injection of triamcinolone may offer certain advantages over bevacizumab in the short-term management of refractory diabetic macular oedema, specifically with regard to changes in central macular thickness. The actual clinical relevance of our preliminary findings, however, remains to be determined in future larger studies.

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  • Funding: Supported in part by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), grant no. 302940/2005-7; Fundação de Amparo è Pesquisa do Estado de São Paulo (FAPESP), grant no. 2006/55080-5.

  • Competing interests: None.

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