Short-term effect of a single intravitreal injection of bevacizumab (Avastin) alone, triamcinolone alone, or in combination, followed by macular grid laser photocoagulation on diffuse diabetic macular edema

Abstract

Purpose This study aimed to perform a short-term evaluation of best-corrected visual acuity (BCVA) and assess improvement central foveal thickness (CFT) in patients with diffuse diabetic macular edema (DME) after an intravitreal injection of triamcinolone alone, bevacizumab (Avastin) alone, or a combination of both, followed by modified grid macular laser photocoagulation. Study design This was a randomized prospective interventional study. Materials and methods This was a randomized prospective interventional study that included 90 eyes of 78 patients with diffuse DME, divided into three groups of interventions: group A received a single intravitreal triamcinolone injection, group B received a single bevacizumab (Avastin) injection, and group C received a single injection of both, followed by a modified grid macular laser photocoagulation 2 weeks after the injection. Patients were observed for a 6-month period and their BCVA, intraocular pressure (IOP), and CFT were recorded. Results In group A, the mean preoperative BCVA was 0.17 ± 0.15 and 0.345 ± 0.211 decimal at 6 months, in group B, the mean preoperative BCVA was 0.245 ± 0.162 and 0.462 ± 0.171 decimal at 6 months, and in group C, the mean preoperative BCVA was 0.238 ± 0.152 and 0.617 ± 0.200 decimal at 6 months, with a statistically significant improvement in all groups throughout the follow-up period ( P In group A, the mean preoperative CFT was 458.17 ± 79.4 μm and at 6 months the mean CFT was 358.53 ± 74.92 μm. In group B, the mean preoperative CFT was 398.40 ± 41.17 μm and at 6 months, the mean CFT was 335.10 ± 46.99 μm. In group C, the mean preoperative CFT was 388.00 ± 43.61 μm, and at 6 months, the mean CFT was 304.37 ± 54.44 μm. Statistical analysis of the difference in CFT between 3 and 6 months showed that there was no statistical difference between groups A and B ( P = 0.6), but there was a statistically significant difference when comparing groups A and C ( P = 0.006) and also when comparing groups B and C ( P = 0.003). Conclusion Combined Avastin and triamcinolone intravitreal injection, followed by modified grid macular photocoagulation led to more stable improvement in the treatment of eyes with diffuse DME.