title: Combined high-dose sub-tenon triamcinolone, intravitreal bevacizumab, and laser photocoagulation for refractory diabetic macular edema: a pilot study.
abstract: OBJECTIVE
  To study the efficacy and safety of triple therapy (sub-Tenon triamcinolone [∼70 mg], intravitreal bevacizumab [1.25 mg], and focal/grid laser) for refractory diabetic macular edema.
  
  
  METHODS
  Twenty-nine eyes of 29 patients who received triple therapy were monitored for central foveal thickness, best-corrected visual acuity (BCVA), and side effects over a 1-year period. Their results were compared with a focal/grid laser historical control group of 18 eyes (18 patients).
  
  
  RESULTS
  In the triple therapy group, mean central foveal thickness significantly reduced from baseline value of 441 μm to 298 μm at Month 12 (P < 0.001), but there was no significant change of BCVA. In the control group, there were no sustained significant changes of central foveal thickness or BCVA. A subgroup analysis of 7 eyes in the triple therapy group with baseline BCVA of ≤20/100 showed significant BCVA improvements from 4 weeks to 9 months. The maximum improvement was achieved at 6 months, when the mean BCVA improved by 9.5 Early Treatment Diabetic Retinopathy Study letters from baseline. Intraocular pressure rise (31.0%), partial ptosis (17.2%), and significant cataractogenesis (8.7%) were encountered in the triple therapy group but not in the control group.
  
  
  CONCLUSIONS
  Sustained reduction of central foveal thickness was achieved with triple therapy over the 1-year study period. Significant visual improvement was seen only in patients with worse baseline BCVA, but not in the triple therapy group as a whole. Significant side effects of intraocular pressure rise, ptosis, and cataractogenesis were encountered in the triple therapy group.
authors.affiliation: Department of Ophthalmology &Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Carmen K M
authors.initials: CK
authors.lastname: Chan
authors.forename: Timothy Y Y
authors.initials: TY
authors.lastname: Lai
authors.forename: Shaheeda
authors.initials: S
authors.lastname: Mohamed
authors.forename: Vincent Y W
authors.initials: VY
authors.lastname: Lee
authors.forename: David T L
authors.initials: DT
authors.lastname: Liu
authors.forename: Chi-Lai
authors.initials: CL
authors.lastname: Li
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D003930:Diabetic Retinopathy / Q000473:pathology / Q000628:therapy*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D014221:Triamcinolone / Q000008:administration & dosage*; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D014221:Triamcinolone; D000068258:Bevacizumab