title: Comparative effectiveness of intravitreal bevacizumab with or without triamcinolone acetonide for treatment of diabetic macular edema.
abstract: BACKGROUND
  Bevacizumab and triamcinolone acetonide (TA) are both common choices for treatment of diabetic macular edema (DME), but the comparative efficacy of combined or separate applications is still not determined.
  
  
  OBJECTIVE
  To compare the treatment efficacy of intravitreal bevacizumab (IVB) and the combination of IVB and intravitreal triamcinolone (IVT) for DME patients.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane library were systematically reviewed for randomized controlled trials comparing IVB with IVB/IVT. Data on visual acuity (VA) and central macular thickness (CMT) changes at 3 and 6 months were extracted and data on adverse events were collected. A meta-analysis was performed using the software RevMan 5.3. The methodological quality and bias risks were also evaluated.
  
  
  RESULTS
  VA improved more significantly in the IVB/IVT group compared with the IVB group at 3 months (mean difference [MD] = 0.07; 95% CI = 0.01 to 0.13), whereas there was no significant difference at 6 months (MD = -0.01; 95%CI = -0.11 to 0.09). The CMT reduction in the IVB/IVT group was significantly greater than that in the IVB group at 3 months (MD = 48.40; 95%CI = 30.23 to 66.57), but no statistically significant difference was found at 6 months (MD = 0.47; 95%CI = -24.11 to 25.04). Ocular hypertension was detected in 9/243 eyes in the IVB/IVT group but none of the IVB eyes.
  
  
  CONCLUSIONS
  IVB/IVT is more effective for improving VA and decreasing CMT at 3 months in DME. A single injection of TA along with the first IVB could improve outcome within 3 months, but this is not sustained at 6 months. Continuous IVT/IVB treatment should be performed in further trials to clarify its long-term potential efficacy.
authors.affiliation: Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China.
authors.forename: Enzhong
authors.initials: E
authors.lastname: Jin
authors.affiliation: The 306th Hospital of PLA, Beijing, People's Republic of China.
authors.forename: Ling
authors.initials: L
authors.lastname: Luo
authors.affiliation: Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China.
authors.forename: Yujing
authors.initials: Y
authors.lastname: Bai
authors.affiliation: Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China zhaomingwei@medmail.com.cn ling.luoling1208@gmail.com.
authors.forename: Mingwei
authors.initials: M
authors.lastname: Zhao
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use*; D000068258:Bevacizumab; D003930:Diabetic Retinopathy / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide
keywords: diabetes; drug utilization review; evidence-based medicine; meta-analysis; ophthalmology