title: Comparison of intravitreal bevacizumab, intravitreal triamcinolone acetonide, and macular grid augmentation in refractory diffuse diabetic macular edema: A prospective, randomized study.
abstract: BACKGROUND
  In spite of laser being the gold standard treatment for Diabetic Macular edema (DME), some patients do not respond to laser. Various treatment modalities are being tried in the management of refractory diffuse DME (DDME).
  
  
  OBJECTIVE
  To compare the efficacy of intravitreal bevacizumab (IVB), intravitreal triamcinolone acetonide (IVTA), and macular grid augmentation in the management of refractory DDME.
  
  
  METHODS
  Prospective randomized study in a tertiary eye care center.
  
  
  METHODS
  SIXTY PATIENTS WITH REFRACTORY DDME WERE RANDOMLY ASSIGNED TO THREE GROUPS: Group 1 received IVB (1.25 mg/0.05 ml), Group 2 received IVTA (4 mg/0.1ml), and Group 3 underwent laser augmentation. Primary outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) at the end of 6 months.
  
  
  METHODS
  Analysis was performed using SPSS 14.0
  
  
  RESULTS
  Group 1 and 2 showed significant improvement in mean BCVA from 20/160 at baseline to 20/80 and from 20/125 to 20/63, respectively, at 6 months (P < 0.05). These groups also showed a significant reduction in the mean CMT from 457 ± 151 μ at baseline to 316 ± 136 μ and from 394 ± 61 μ to 261 ± 85 μ, respectively, at 6 months (P < 0.05). Group 3 showed only small improvement in mean BCVA from 20/100 to 20/80 (P = 1.0) while mean CMT increased from 358 ± 89 μ at baseline to 395 ± 127 μ at 6 months (P = 0.191). Eight (40%) eyes in Group 2 had intraocular pressure (IOP) rise and 10 (50%) eyes developed cataract.
  
  
  CONCLUSIONS
  Both IVB and IVTA may be effective in the treatment of refractory DDME compared with macular grid augmentation. IVTA may be associated with side effects such as IOP rise and cataract formation.
authors: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institue of Medical Sciences, New Delhi, India.
authors: Rajvardhan
authors: R
authors: Azad
authors: Siddarth
authors: S
authors: Sain
authors: Yog Raj
authors: YR
authors: Sharma
authors: Deepankur
authors: D
authors: Mahajan
keywords: Diabetic macular edema; Intravitreal bevacizumab; Intravitreal triamcinolone; laser photocoagulation