Single intravitreal injection of triamcinolone combined with bevacizumab for the treatment of diffuse diabetic macular oedema refractory to grid photocoagulation
Year: 2009
Type: article
Abstract: Editor, The effectiveness of intravitreal injection of triamcinolone acetonide (IVT) and/or antiangiogenic agents, such as bevacizumab (IVB), has been investigated in the management of refractory cases of diabetic macular oedema (DMO) (Bakri & Kaiser 2005; Bonini-Filho et al. 2005; Gillies et al. 2006; Paccola et al. 2008), but only one recent report shows the results of combination therapy with IVT and IVB for refractory DMO (Ahmadieh et al. 2008). In the latter study, the authors reported that the addition of IVT to a treatment regimen of IVB might be associated with more rapid visual acuity improvement. In this study, we investigated the short-term effects of a single intravitreal injection of 2 mg IVT combined with 1.25 mg IVB on central macular thickness (CMT) measured by optical coherence tomography, and best-corrected visual acuity (BCVA) in eyes with diffuse DMO unresponsive to macular grid photocoagulation. Refractory DMO was defined herein as the presence of clinically significant macular oedema by biomicroscopic evaluation that has persisted despite at least one session of macular grid photocoagulation performed at least 3 months previously, associated with diffuse fluorescein leakage involving the fovea and most of the macular area on fluorescein angiography. BCVA was 0.3 LogMAR (20/40) or worse, and CMT > 300 μm. Patients were scheduled for follow-up examinations at 1, 4, 8 ± 1, 12 ± 2 and 24 ± 2 weeks after injection. BCVA and CMT values for each patient at each follow-up visit are displayed in Table 1. There was a statistically significant (p < 0.05) BCVA improvement of approximately 0.2 LogMAR (i.e. the equivalent of going from 20/80 to 20/50) between the 4th and 8th weeks after treatment, combined with a statistically significant CMT reduction of 17%, 32% and 22% at 1, 4 and 8 weeks after treatment, respectively (Fig. 1). There was a small but statistically significant [mean ± standard error (SE)] increase of 2.1 ± 0.6 mmHg (17%), recorded only at the 4th week after treatment (Fig. 1). (A) Means (connected markers) and 95% confidence limits (error bars) of the intra-individual differences of best-corrected visual acuity (BCVA) (LogMAR). (B) Intra-individual ratio of central macular thickness (CMT) (%). (C) Intra-individual differences of intraocular pressure (IOP) (mmHg) versus follow-up time (weeks). *Indicates within-group statistically significant changes from baseline values (p < 0.05). These results suggest that a single treatment session consisting of IVT and IVB in eyes with refractory diffuse DMO is associated with a significant improvement in visual acuity and CMT reduction. Effects on CMT were detected as early as 7 days after treatment and lasted for at least 8 weeks. We have reported previously that IVT at 4 mg induces longer-lasting CMT reduction and BCVA improvement (Paccola et al. 2008) than the combination used in this study (IVT 2 mg + IBV 1.25 mg). On the other hand, in this study we showed that IVT at 2 mg plus IVB is associated with a similar amount of maximal CMT reduction (around 30% at 4th week) and BCVA improvement (around −0.2 LogMAR at 8th week) compared with that associated with IVT at 4 mg alone. These findings suggest that the addition of IVB enhanced the effect of IVT at this lower dose without increasing the risk of side-effects. Supported in part by Fundação de Apoio a Pesquisa, Ensino e Assistência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (FAEPA). Clinical Trial register: NCT00468351.
Source: Acta Ophthalmologica
Institutions: Universidade de São Paulo, Pennsylvania State University
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2078260483