Reduction in the frequency of intravitreal bevacizumab administrations achieved by posterior subtenon injection of triamcinolone acetonide in patients with diffuse diabetic macular edema.
OBJECTIVE
To evaluate the effectiveness of posterior subtenon injections of triamcinolone acetonide (STTA) during treatment with intravitreal injections of bevacizumab (IVB) in eyes with diffuse diabetic macular edema (DDME).


METHODS
Forty eyes of 20 patients with bilateral DDME with foveal thickness (FT) greater than 400 μm were studied. Initially, both eyes of each patient received 1.25 mg/0.05 ml of IVB. One eye then received 20 mg/0.5 ml of STTA at the onset and at 16, 32, and 48 weeks. For the control, the other eye was not treated with STTA. Patients were treated with additional IVB when DDME recurred during the study to maintain the FT at <350 μm. The FT, logMAR visual acuity (VA), and intraocular pressure (IOP) were monitored monthly for 56 weeks. The total number of IVB injections during the 1-year follow-up was also calculated.


RESULTS
STTA-treated eyes had significantly more regression of FT and improvement of VA at several time points during the study than did the controls. The mean (SD) required number of IVB injections in the STTA-treated eyes during the study was 5.00 ± 1.75, which was significantly less than the 7.95 ± 1.57 in the control eyes.


CONCLUSIONS
Adjunctive STTA therapy to IVB for the treatment of DDME not only improved the morphological and functional regressions but also reduced the frequency of IVB treatments.
Department of Ophthalmology, NTT East Japan Tohoku University Hospital, Sendai, Japan. masahiko@v101.vaio.ne.jp.|Department of Ophthalmology, Tokyo Medical University, Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo, 193-0998, Japan. masahiko@v101.vaio.ne.jp.
Masahiko
M
Shimura
Department of Ophthalmology, NTT East Japan Tohoku University Hospital, Sendai, Japan.|Department of Ophthalmology, Tokyo Medical University, Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo, 193-0998, Japan.
Kanako
K
Yasuda
Department of Ophthalmology, Tokyo Medical University, Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo, 193-0998, Japan.
Teruumi
T
Minezaki
Department of Ophthalmology, Tokyo Medical University, Hachioji Medical Center, 1163 Tate-machi, Hachioji, Tokyo, 193-0998, Japan.
Hidetaka
H
Noma
D000368:Aged; 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; D005500:Follow-Up Studies; 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; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014792:Visual Acuity
D020533:Angiogenesis Inhibitors; D005938:Glucocorticoids; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide
Bevacizumab; Combination therapy; Diabetic macular edema; Subtenon injection; Triamcinolone acetonide