title: Comparison of intravitreal triamcinolone acetonide with intravitreal bevacizumab for treatment of diabetic macular edema: a meta-analysis.
abstract: OBJECTIVE
  To compare the effects of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) injections for the treatment of diabetic macular edema (DME).
  
  
  METHODS
  A literature search was conducted using PUBMED, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. Pooled mean differences (MDs) for changes in visual acuity (VA) and central macular thickness (CMT) were calculated between groups receiving a single TA (4 mg) and bevacizumab (1.25 or 1.5 mg) from baseline to 4, 8, 12 and 24 weeks after treatment, respectively. Changes in intraocular pressure (IOP) were calculated between the two groups from baseline to 4, 8 and 12 weeks after treatment.
  
  
  RESULTS
  Eight trials (n = 434 eyes) comparing the efficacy of IVTA with IVB were included in the meta-analysis. Patients in the IVTA group demonstrated significant post-treatment improvement in VA compared with those in the IVB group at 4 (MD = -0.08; 95% confidence interval [CI]: -0.12 to -0.03; p = 0.0008), 8 (MD = -0.15; 95% CI: -0.20 to -0.11; p < 0.00001), 12 (MD = -0.11; 95% CI: -0.15 to -0.06; p < 0.0001) and 24 (MD = -0.05; 95% CI: -0.10 to -0.01; p = 0.02) weeks. After receiving IVTA, MDs in CMT decreased significantly at 4 weeks (MD = -40.05 μm; 95% CI: -75.29 to -4.81; p = 0.03). No significant differences in CMT were seen between the two groups at 8, 12 and 24 weeks post-treatment. Fluctuations of IOP were within normal range for both groups throughout the entire observation period.
  
  
  CONCLUSIONS
  Results of this meta-analysis suggest that IVTA is more effective for improving VA in DME. However, the CMT reduction with IVTA was unsustainable. Additional well-designed studies are needed to further investigate optimal interventions.
authors: Department of Health Care, QiLu Hospital of Shandong University, Jinan, China.
authors: Yue
authors: Y
authors: Zhang
authors: Jinlan
authors: J
authors: Ma
authors: Nana
authors: N
authors: Meng
authors: Hao
authors: H
authors: Li
authors: Yi
authors: Y
authors: Qu
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D003930:Diabetic Retinopathy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide