title: The effect of combined treatment of bevacizumab and triamcinolone for diabetic macular edema refractory to previous intravitreal mono-injections.
abstract: The purpose of this study is to evaluate the efficiency of combined treatment of bevacizumab and triamcinolone in refractory diffuse DME (DDME). Twenty-five pseudophakic eyes with DDME refractory to previous successive intravitreal bevacizumab (IVB, 1.25 and 2.5 mg/0.1 ml) and triamcinolone (IVT, 4 mg and 10 mg/0.1 ml) injections were included. The average number of injections was two (1-4). The mean best corrected visual acuity (BCVA) was 0.8 (0.3-1.5) logMAR before enrollment, 0.6 (0.0-1.5) logMAR at 6 months and 0.6 (0-1.8) logMAR at 12 months (p = 0.0001, p = 0.003). The median central macular thickness (CMT) of all the eyes was 575 (502-1049) µm at baseline, 370 (179-983) µm at 6 months, and 410 (198-929) µm at 12 months (p = 0.0001; p = 0.0001). At 6 months, the VA of 13 (52 %) patients was stabilized (± 0.2 logMAR of initial BCVA) and 12 (48 %) patients showed visual improvement (>0.2 logMAR). At 12 months, 10 (40 %) patients had stabilized vision, 13 (52 %) showed visual improvement and 2 (8 %) showed visual loss. At 6 months, 18 (72 %) patients showed anatomic stabilization (a decrease of 10 % to 50 % in initial CMT) and 7 (28 %) anatomical success (a decrease in CMT more than 50 % or ≤250 µm at final visit). At 12 months, 13 (52 %) patients showed anatomic stabilization, 10 (40 %) anatomic success, and 2 (8 %) anatomical failure (decrease in CMT less than 10 %). The combined application of IVB and triamcinolone may improve vision and decrease CMT in severe DDME cases refractory to previous monotherapies.
authors.affiliation: Department of Ophthalmology, GATA (Gulhane Military Medical Academy and Medical School), Ankara, Turkey. umit_yolcu@hotmail.com.
authors.forename: Ümit
authors.initials: Ü
authors.lastname: Yolcu
authors.affiliation: Department of Ophthalmology, GATA (Gulhane Military Medical Academy and Medical School), Ankara, Turkey.
authors.forename: Güngör
authors.initials: G
authors.lastname: Sobaci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000187:drug effects / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D014221:Triamcinolone; D000068258:Bevacizumab
keywords: Bevacizumab; Combined treatment; Diabetic macular edema; Triamcinolone