Comparison of Visual and Anatomical Outcomes of Intravitreal Triamcinolone Acetonide Injection Versus Bevacizumab in Patients with Bulky Diabetic Macular Edema
Alireza Zare mehrjardi1 *, Alireza Ramezani1
- Department of ophthalmology - Shahid Beheshti medical University
Abstract: Diabetic macular edema (DME) is one of the most common causes of vision impairment in patients with diabetic retinopathy. Current treatments include intravitreal injections of anti-VEGF agents (e.g., bevacizumab) and corticosteroids (e.g., triamcinolone acetonide). This study aimed to compare the visual and anatomical outcomes, specifically the reduction in central macular thickness (CMT) and improvement in visual acuity (VA), in patients with Bulky DME and CMT ≥500 microns treated with triamcinolone or bevacizumab.
Methods: This randomized controlled trial (RCT) included 57 patients (79 eyes) with refractory DME and baseline CMT ≥500 microns. Patients were randomly assigned to receive either triamcinolone acetonide (2 mg) or bevacizumab (1.25 mg). Outcomes, including CMT (measured by OCT) and VA (measured by LogMAR), were assessed at baseline, and every months for 6 months post-treatment. Statistical analyses were performed using independent t-tests and repeated measures ANOVA.
Results: In this study, both triamcinolone acetonide and bevacizumab were effective in reducing central macular thickness and improving visual acuity in patients with Bulky diabetic macular edema (DME>500 microns). However, in the triamcinolone group, the reduction in macular thickness and improvement in visual acuity were marginally greater than in the bevacizumab group. The differences observed in both macular thickness and visual acuity (p=0.047 and p=0.048) were statistically significant but borderline. These results suggest that both treatments are effective options for patients with Bulky DME, but triamcinolone may offer a slight advantage in reducing macular thickness and improving visual acuity.
Conclusion: While both triamcinolone and bevacizumab were effective for Buly DME, triamcinolone demonstrated a borderline superiority in reducing central macular thickness (CMT) and improving visual acuity (VA). Specifically, the reduction in CMT and improvement in VA were slightly greater in the triamcinolone group. These findings suggest that both treatments are viable options for Bulky DME, but triamcinolone may offer a slight advantage. Treatment choice should be tailored to individual patient needs, considering the potential risks and benefits of each therapy.
