Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with bilateral diabetic macular edema

2020 ◽  
Vol 1 (3) ◽  
pp. 183-189
Author(s):  
Sever Ozkan ◽  
◽  
Celik Erkan ◽  
Topcu Birol ◽  
◽  
...  
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Randomized Study ◽  
Intravitreal Bevacizumab ◽  
Diabetic Patients ◽  
Steroid Dependent ◽  
Bilateral Diabetic Macular Edema

AIM: To Compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema. METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab (IVB group) was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide (IVTA-IVB group) was performed. Main outcomes were the central macular thickness (CMT) measured with optical coherence tomography (OCT), ETDRS visual acuity (VA) and intraocular pressure (IOP). RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 µm and 546.8±165.6 µm before injections; 430.4±133.2 µm and 363.7±105.3 µm at first month; 484.8±167.4 µm and 407.3±108.7 µm at 3rd month; 550.4±191.5 µm and 516.8±158 µm after 6mo respectively. Differences were significant at first and 3rd month (P?0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 at first month; 59±13.7 and 59.3±13.6 at 3rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant at first and 3rd and 6mo (P?0.05). There was no IOP difference. IVTA-IVB group gains best VA at 3rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo. CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.

Correlation of response to intravitreal bevacizumab treatment between the first and second treated eyes in diabetic macular edema

2021 ◽  
pp. 112067212110596
Author(s):  
Nadav Levinger ◽  
Liran Tiosano ◽  
Elishai Assayag ◽  
Rivkah Lender ◽  
Tomer Batash ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Thickness Reduction ◽  
Bevacizumab Treatment ◽  
Central Subfield Thickness ◽  
Bilateral Diabetic Macular Edema ◽  
The Mean ◽  
Selection Of

Purpose To evaluate whether outcome of bevacizumab treatment in the first treated eye can guide the selection of compound for the second treated eye in patients with bilateral diabetic macular edema. Methods Demographic, clinical, and optical coherence tomography data were retrospectively collected from consecutive patients who underwent bevacizumab therapy for bilateral diabetic macular edema. Change in central subfield thickness and visual acuity were evaluated and compared between the first treated eye and second treated eye. Results A total of 66 eyes of 33 patients were included in the study. The mean ± SD follow-up time was 13 ± 5 months. The mean ± SD central subfield thickness at baseline was 464 ± 30 μm in the first treated eye and 461 ± 29 μm in the second treated eye ( p = 0.91). Final central subfield thickness was reduced to 392 ± 27 μm in the first treated eye ( p = 0.01 compared with baseline) and 416 ± 25 μm in the second treated eye ( p = 0.03 compared with baseline). Using ≥5% or ≥10% reduction of central subfield thickness as diagnostic criteria to predict similar magnitude of thickness reduction in the first treated eye yielded a positive and negative predictive value ranging from 46% to 81%, and sensitivity and specificity ranging from 54% to 84%. Regression models did not show correlation between central subfield thickness reduction in first treated eye and the second treated eye at the end of follow-up. Conclusions Bevacizumab therapy reduced macular thickness in both eyes in bilateral diabetic macular edema. Treatment outcome of the first treated eye could not predict the outcome of the second treated eye. Particularly, failure to reduce central subfield thickness in the first treated eye does not preclude a favorable response to bevacizumab therapy in the second eye.

scholarly journals DIABETIC MACULAR EDEMA;

2018 ◽  
Vol 21 (04) ◽  
pp. 810-815
Author(s):  
Fuad Ahmad Khan Niaz ◽  
Bilal Humayun Mirza ◽  
Manal Niazi ◽  
Muhammad Afzal Khan Niaz
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outcome Measure ◽  
Case Series ◽  
Intravitreal Bevacizumab ◽  
Diabetic Patients ◽  
Main Outcome Measure ◽  
Clinically Significant Macular Edema ◽  
Clinically Significant

. OBJECTIVE: To evaluate the effect of Intravitreal Bevacuzimab on Best CorrectedVisual Acuity in patients with clinically significant diabetic macular edema. MATERIAL ANDMETHODS: A prospective uncontrolled interventional case series in which 42 eyes of 31consecutive diabetic patients with clinically significant macular edema and no significantcomorbid ocular association presenting in the outpatients department of Holy Family Hospitaland EYE SURGERY clinic, Rawalpindi Pakistan and opting for the treatment from 1st September2013 to 31st January 2014 were given an intravitreal injection of Bevacizumab. BCVA wasdocumented prior to and four weeks after the injection. Main outcome measure was changes inBCVA. RESULTS: Out of the 31 patients included in the study 14(45.16%) were male and 17(54.83%) female. Average age was 56.1 ± 7.6. All 31 patients (42 eyes) came for follow up andtheir BCVA recorded. 41 (97.61%) eyes showed an improvement of one or more line on Snellen'schart at 4 weeks. 14 (33.33%) eyes showed an improvement of one line, 19 (45.23%) eyes animprovement of two lines, 6 (14.28%) eyes three lines and just 2 (4.76%) eyes had animprovement of four lines on Snellen's chart at 4 weeks. Only 1(2.38%) eye remained same withno worsening. On logMAR conversion scale for Snellen's letters the BCVA improved from 0.76 ±0.27 to 0.47 ± 0.27 (p< 0.001). No significant complications were observed in any of the eyes.CONCLUSION: The use of intravitreal Bevacizumab (1.25mg/0.05ml) is a safe and effective moeof treatment for clinically significant diabetic macular edema.

scholarly journals Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257695
Author(s):  
Francesco Saverio Sorrentino ◽  
Claudio Bonifazzi ◽  
Francesco Parmeggiani
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Foveal Thickness ◽  
Intravitreal Triamcinolone ◽  
Central Foveal Thickness ◽  
Preservative Free

Purpose To suggest the safety and efficacy of preservative-free triamcinolone acetonide intravitreal injectable suspension (Taioftal) for the treatment of diabetic macular edema. Methods A prospective clinical study involved 49 patients (49 eyes), that were treated with Taioftal and followed-up for six months. Complete ophthalmic examination, including spectral domain optical coherence tomography, was performed at baseline, and at month 1, 3, 6 after the intravitreal injection. Accurate collection and analysis of best-corrected visual acuity (BCVA), central foveal thickness (CFT), intraocular pressure (IOP), and adverse events (AEs) were carried out in order to evaluate visual function and macular morphology before and after treatment Results Median BCVA value chosen as comparing statistics was significantly improved at every follow-up time points (gain of 6 letters at month 1, 12 at month 3 –improvement up to 24% at month 3 with stabilization until month 6) compared to baseline, as certified by Kruskal-Wallis rank sum test (P<0.05). Median CFT significantly waned at each follow-up times (decrease of about 65 μm at month 1, 155 at month 3 –reduction up to 28% at month 3 keeping good outcome until month 6) compared to baseline (P<0.05). IOP elevation, with no severe increases, was the most common among spotted AEs (median of 23 mmHg at month 1, 20 at month 3). Conclusion Intravitreal injection of preservative-free triamcinolone (Taioftal) is an effective, safe and inexpensive drug used to improve visual acuity and reduce central foveal thickness in eyes affected by diabetic macular edema during an average time of 6 months. Temporary, never severe, elevation of IOP is totally manageable with topical medications. No serious vision-threatening complications are related to the use of intravitreal triamcinolone injections.

Efficacy of posterior sub-Tenon’s capsule injection compared to intravitreal injection of triamcinolone acetonide for treatment of diabetic macular edema: A systematic review and meta-analysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed H Ibrahim ◽  
Abdelrahman G Salman ◽  
Azza M Said ◽  
Mariam A Al-Feky ◽  
Moustafa E Moustafa
Keyword(s):  
Systematic Review ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Meta Analysis ◽  
Significant Difference ◽  
The Mean ◽  
Iop Elevation

Abstract Background Diabetic macular edema (DME) is defined as a retinal thickening in one-disc diameter (DD) of the centre of the macula. It is a number of microvascular retinal changes that lead to blood–retinal barrier (BRB) disruption, causing leakage of fluid and plasma components into the inner and outer plexiform layers. Aim of the Work to conduct a systematic review and a meta-analysis estimating the efficacy and complications of posterior sub-Tenon’s capsule injection of triamcinolone acetonide (STTA) compared to intravitreal injection of triamcinolone acetonide (IVTA) for management of DME. Materials and Methods A comprehensive literature search was conducted using the databases Google scholar, PubMed, MEDS, web of science, EMBASE and Cochrane Library for published studies from 1 January 2000 to 1 September 2019.This meta-analysis included ten studies. They were randomized controlled clinical trials (RCTs), and about 343 patients with DME (469 eyes) participated in these studies. Results : This study demonstrated a statistically significant change in the mean of best corrected visual acuity (BCVA) improvement and central macular thickness (CMT) reduction in both groups when comparing the baseline to one- and three-month follow-ups after the injection, though with no statistically significant difference in the IVTA compared to the STTA group. At a six-month follow-up, both groups showed no significant differences in the BCVA and CMT compared to the baseline. Both groups showed no statistical differences in the BCVA or CMT over the follow-up periods. Regarding intraocular pressure (IOP) changes, the present study showed that the mean IOP was elevated in both groups at one- and three-month follow-ups after the injection compared to their baseline. There was a statistically significant difference between both groups at one and three-months. The IOP was more elevated in the IVTA compared to the STTA group. At a six-month follow-up, both groups showed no significant difference in the IOP elevation compared to the baseline. IOP elevation was the most reported adverse effect in all included studies. Cataract formation is also reported in some studies, though no other complications, such as endophthalmitis, vitreous hemorrhage (VH), and/or retinal detachment (RD), are reported in any of the studies. Conclusion : STTA injection has a comparable effect to the IVTA injection and carries a lower risk of intraocular complications. It is considered an easy, safe, and valid alternative to the intravitreal injection for the treatment of DME.

Current Therapy of Diabetic Macular Edema Bevacizumab, Triamcinolone Acetonide, and Laser Photocoagulation

2019 ◽  
Vol 45 (1) ◽  
pp. 13
Author(s):  
Gladys Kusumowidagdo ◽  
Randy Sarayar ◽  
Kartika Rahayu ◽  
Gitalisa Andayani
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Systematic Reviews ◽  
Laser Photocoagulation ◽  
Meta Analysis ◽  
Intravitreal Bevacizumab ◽  
Current Therapy ◽  
Intravitreal Triamcinolone ◽  
Mesh Terms

Background: Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy (DR). Current gold standard therapy of DME is macular laser photocoagulation (MPC). Growing evidences have shown benefits of intravitreal anti-VEGF agents (i.e bevacizumab) and intravitreal corticosteroids (i.e triamcinolone acetonide). Aim: To compare the visual acuity (VA) improvement of patients with DME, treated with intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone (IVB/IVT), and MPC. Method: A comprehensive PubMed® and Cochrane® databases search was conducted on May 4th, 2017 using appropriate keywords (diabetic macular edema, bevacizumab, triamcinolone, and laser photocoagulation using their MeSH terms). Studies were filtered using inclusion criterions (clinical trials, RCT, meta-analysis, systematic review, English, humans, and publication within 10 years) Results: Three studies (2 systematic reviews and 1 RCT) were found suitable. From these results, all studies showed favoring effects of IVB when compared to IVB/IVT combination and MPC in short term period (up to 6 months). However, there was no significant improvement of VA beyond this period in all groups. Conclusion: IVB appears to be superior to IVB/IVT and MPC in improving VA during 6 months follow- up period. Future systematic reviews and meta-analysis are required on the effect of IVB and MPC combination in cases of DME.

scholarly journals EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR DIABETIC MACULAR EDEMA

2016 ◽  
Vol 3 (2) ◽  
pp. 30-34
Author(s):  
Prachand Gautam ◽  
Koshal Shrestha ◽  
Gyanendra Lamichhane ◽  
Sushila Patel
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Intravitreal Triamcinolone ◽  
Hard Exudates ◽  
Intravitreal Triamcinolone Acetonide ◽  
Diffuse Diabetic Macular Edema

INTRODUCTION: Diabetic retionopathy is a microangilpathy. The present study was done to investigate results of Intravitreal Triamcinolone Acetonide injection for the treatment diffuse diabetic macular edema. MATERIAL AND METHODS: The study included 40 eyes of 40 patients with clinically significant diffuse diabetic macular edema. Eyes were diagnosed with diabetic macular edema according to Early Treatment Diabetic Retinopathy Study guidelines. An Intravitreal injection of Triamcinolone Acetonide at the dose of 4 mg/0.2 ml was administered. Best corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR) and snellen vision drum and size of macular edema (hard exudates) was obtained by slit lamp biomicroscopy using +90 D Volk lens at each visit. Intraocular pressure (IOP) and other complications related with steroid and injection related complications were also evaluated. Subsequently patients were followed up on 1st day, 2nd week and 3rd month. RESULTS: All patients were completed second follow up at 3 months. The mean size of macular edema, which obtained at 3 months postoperatively, was significantly different from the baseline measurement from 1.4125 to 0.9474 DD. Mean visual acuity improved significantly from baseline at 3 months of follow up was 0.7421 LogMAR (≈ 6/30 in Snellen chart). Eleven eyes developed intraocular pressure higher than 21 mmHg at 2nd week postoperatively. Other drug and injection related complications were not developed. Increased IOP were controlled with anti glaucoma drugs. CONCLUSIONS: Intravitreal Triamcinolone was a promising therapeutic method for diabetic macular edema. TriamcinoloneAcetonide effectively reduces size of macular edema and improves visual acuity in the short term.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10 Page: 30-34

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