Korean J Ophthalmol.  2011 Jun;25(3):156-160. 10.3341/kjo.2011.25.3.156.

Comparison of the Short-Term Effects of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection for Diabetic Macular Edema

• Song JH
• Lee JJ
• Lee SJ

• KMID: 1010021
• DOI: http://doi.org/10.3341/kjo.2011.25.3.156

Abstract

PURPOSE
To compare the short-term effects of intravitreal triamcinolone acetonide (IVTA) with those of intravitreal bevacizumab (IVB) injection for diabetic macular edema (DME).
METHODS
The present retrospective, comparative case study included 58 eyes of 35 consecutive patients (IVTA group, 20 eyes; IVB group, 38 eyes) with DME. IVTA (4 mg) or IVB (1.25 mg) injection was performed under local anesthesia. The effects of injection for DME were evaluated using best-corrected visual acuity (BCVA), central macular thickness (CMT) by optical coherence tomography and intraocular pressure (IOP) by applanation tonometer. Patients underwent eye examinations, including BCVA, CMT, and IOP at pre-injection, 2, 4, and 8 weeks after injection.
RESULTS
BCVA (logarithm of the minimum angle of resolution) +/- SD at pre-injection, 2, 4, and 8 weeks after injection was 0.67 +/- 0.40, 0.56 +/- 0.35 (p = 0.033), 0.55 +/- 0.33 (p = 0.041), and 0.43 +/- 0.31 (p = 0.001) in the IVTA group and 0.51 +/- 0.31, 0.42 +/- 0.26 (p = 0.003), 0.43 +/- 0.32 (p = 0.001), and 0.43 +/- 0.27 (p = 0.015) in the IVB group, respectively. CMT (microm) +/- SD at pre-injection, 2, 4, and 8 weeks after injection was 400.4 +/- 94.9, 332.8 +/- 47.4 (p = 0.002), 287.5 +/- 49.1 (p = 0.007), and 282.5 +/- 49.6 (p = 0.043) in the IVTA group and 372.6 +/- 99.5, 323.2 +/- 72.4 (p = 0.077), 360.9 +/- 50.3 (p = 0.668), 368.2 +/- 88.6 (p = 0.830) in the IVB group, respectively.
CONCLUSIONS
The effects of IVTA for BCVA were more favorable than were those of IVB and were consistent throughout the eight weeks after injection. IVTA significantly reduced CMT during the eight weeks after injection, while IVB did not.

Keyword

Bevacizumab; Diabetic retinopathy; Intraocular pressure; Macular edema; Triamcinolone acetonide

MeSH Terms

Aged
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Diabetic Retinopathy/*drug therapy
Female
Glucocorticoids/*administration & dosage
Humans
Intravitreal Injections
Macular Edema/*drug therapy
Male
Middle Aged
Retrospective Studies
Time Factors
Treatment Outcome
Triamcinolone Acetonide/*administration & dosage

Figure

• 

  Fig. 1 Change in central macular thickness (CMT, µm) after intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) injections during the follow-up period. In the IVTA group, significant reduction in CMT was observed throughout the follow-up period compared with the pre-injection level (p < 0.05). In the IVB group, reduction of CMT was not statistically significant (p < 0.05). The IVTA group had a significant reduction of CMT during the follow-up period compared with that in the IVB group (p < 0.05).

• 

  Fig. 2 Change in intraocular pressure (IOP, mmHg) after intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) injections during the follow-up period. In the IVTA group, significant IOP elevation at 4 and 8 weeks after injection was observed compared with the pre-injection level (p < 0.05). In the IVB group, no significant IOP elevation was observed. The IVTA group had a significant increase in IOP during the follow-up period compared with that in the IVB group (p < 0.05).

Reference

1. William EB. Tasman W, Jaeger EA, editors. Diabetic retinopathy. Duane's clinical ophthalmology on CD-ROM. 2004. Philadelphia: Lippincott Williams & Wilkins;Chapter 30.

2. Jonas JB, Sofker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001. 132:425–427.

3. Audren F, Lecleire-Collet A, Erginay A, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular edema: phase 2 trial comparing 4 mg vs 2 mg. Am J Ophthalmol. 2006. 142:794–799.

4. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002. 109:920–927.

5. Jonas JB. Intravitreal triamcinolone acetonide for diabetic retinopathy. Dev Ophthalmol. 2007. 39:96–110.

6. Massin P, Audren F, Haouchine B, et al. Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial. Ophthalmology. 2004. 111:218–224.

7. Sutter FK, Simpson JM, Gillies MC. Intravitreal triamcinolone for diabetic macular edema that persists after laser treatment: three-month efficacy and safety results of a prospective, randomized, double-masked, placebo-controlled clinical trial. Ophthalmology. 2004. 111:2044–2049.

8. Bonini-Filho MA, Jorge R, Barbosa JC, et al. Intravitreal injection versus sub-Tenon\'s infusion of triamcinolone acetonide for refractory diabetic macular edema: a randomized clinical trial. Invest Ophthalmol Vis Sci. 2005. 46:3845–3849.

9. Karacorlu M, Ozdemir H, Karacorlu S, et al. Intravitreal triamcinolone as a primary therapy in diabetic macular oedema. Eye (Lond). 2005. 19:382–386.

10. Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 2006. 26:999–1005.

11. Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology. 2007. 114:743–750.

12. Cunningham ET Jr, Adamis AP, Altaweel M, et al. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 2005. 112:1747–1757.

13. Chun DW, Heier JS, Topping TM, et al. A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema. Ophthalmology. 2006. 113:1706–1712.

14. Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003. 121:57–61.

15. Ciardella AP, Klancnik J, Schiff W, et al. Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study. Br J Ophthalmol. 2004. 88:1131–1136.

16. Kim HK, Han YB. Laser photocoagulation in diabetic macular edema. J Korean Ophthalmol Soc. 1992. 33:759–763.

17. Paccola L, Costa RA, Folgosa MS, et al. Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study). Br J Ophthalmol. 2008. 92:76–80.

18. Oh SB, Moon JW, Kim HC. Comparison of effects of intravitreal triamcinolone and bevacizumab in the treatment of diabetic macular edema. J Korean Ophthalmol Soc. 2009. 50:1190–1196.

19. Kim HD, Choi KS, Lee SJ. Combined therapy of intravitreal bevacizumab and posterior subtenon triamcinolone acetonide injection in diabetic macular edema. J Korean Ophthalmol Soc. 2009. 50:1652–1656.

20. Bakri SJ, Snyder MR, Pulido JS, et al. Six-month stability of bevacizumab (Avastin) binding to vascular endothelial growth factor after withdrawal into a syringe and refrigeration or freezing. Retina. 2006. 26:519–522.

21. Ornek K, Karahan ZC, Ergin A, et al. Bevacizumab sterility in multiple doses from a single-use vial. Ann Pharmacother. 2008. 42:1425–1428.

22. Chen YH, Wu PC, Shiea J, et al. Evaluation of the sterility, stability, and efficacy of bevacizumab stored in multiple-dose vials for 6 months. J Ocul Pharmacol Ther. 2009. 25:65–69.

23. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008. 115:1447–1449. 1449.e1–1449.e10.

24. McCuen BW 2nd, Bessler M, Tano Y, et al. The lack of toxicity of intravitreally administered triamcinolone acetonide. Am J Ophthalmol. 1981. 91:785–788.

25. Moshfeghi DM, Kaiser PK, Scott IU, et al. Acute endophthalmitis following intravitreal triamcinolone acetonide injection. Am J Ophthalmol. 2003. 136:791–796.

26. Nelson ML, Tennant MT, Sivalingam A, et al. Infectious and presumed noninfectious endophthalmitis after intravitreal triamcinolone acetonide injection. Retina. 2003. 23:686–691.

27. Roth DB, Chieh J, Spirn MJ, et al. Noninfectious endophthalmitis associated with intravitreal triamcinolone injection. Arch Ophthalmol. 2003. 121:1279–1282.

28. Audren F, Erginay A, Haouchine B, et al. Intravitreal triamcinolone acetonide for diffuse diabetic macular oedema: 6-month results of a prospective controlled trial. Acta Ophthalmol Scand. 2006. 84:624–630.

29. Chan CK, Mohamed S, Shanmugam MP, et al. Decreasing efficacy of repeated intravitreal triamcinolone injections in diabetic macular oedema. Br J Ophthalmol. 2006. 90:1137–1141.

30. Konstantopoulos A, Williams CP, Newsom RS, Luff AJ. Ocular morbidity associated with intravitreal triamcinolone acetonide. Eye (Lond). 2007. 21:317–320.

31. Khairallah M, Zeghidi H, Ladjimi A, et al. Primary intravitreal triamcinolone acetonide for diabetic massive macular hard exudates. Retina. 2005. 25:835–839.

32. Bucher RS, Hall E, Reed DM, et al. Effect of intravitreal triamcinolone acetonide on susceptibility to experimental bacterial endophthalmitis and subsequent response to treatment. Arch Ophthalmol. 2005. 123:649–653.

33. Westfall AC, Osborn A, Kuhl D, et al. Acute endophthalmitis incidence: intravitreal triamcinolone. Arch Ophthalmol. 2005. 123:1075–1077.

34. Wu L, Martinez-Castellanos MA, Quiroz-Mercado H, et al. Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008. 246:81–87.

35. Fintak DR, Shah GK, Blinder KJ, et al. Incidence of endophthalmitis related to intravitreal injection of bevacizumab and ranibizumab. Retina. 2008. 28:1395–1399.

36. Mason JO 3rd, White MF, Feist RM, et al. Incidence of acute onset endophthalmitis following intravitreal bevacizumab (Avastin) injection. Retina. 2008. 28:564–567.

37. Diago T, McCannel CA, Bakri SJ, et al. Infectious endophthalmitis after intravitreal injection of antiangiogenic agents. Retina. 2009. 29:601–605.