Single-injection intravitreal bevacizumab versus bevacizumab–triamcinolone for diabetic macular edema: a prospective comparative observational study evaluating efficacy, durability and intraocular pressure safety during 12 weeks of follow-up.

Abstract

Background:

It is the leading cause of visual impairment in DR patients. Intravitreal bevacizumab has become a first-line treatment, and the use of intravitreal triamcinolone has been suggested to augment the response to treatment by inhibiting inflammatory pathways.

Objective:

To evaluate the efficacy, durability, and safety in terms of intraocular pressure of a single intravitreal injection of bevacizumab versus intravitreal bevacizumab–triamcinolone combination in patients with DME during 12 weeks' follow-up.

Methods:

A Prospective Comparative observational study was done at the Regional Institute of Ophthalmology (RIMS), Ranchi. A total of 29 patients with diabetic macular edema (DME) were divided into two groups. Group 1 (n = 14) received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL), while Group 2 (n = 15) received a single intravitreal combination of bevacizumab (1.25 mg/0.05 mL) and triamcinolone acetonide (4 mg/0.1 mL). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were assessed at baseline and at 1, 4, and 12 weeks after treatment.

Result:

In the follow-up, the improvement in BCVA and decrease in CMT were similar in both treatment groups. Numerically, the combination therapy group had a greater functional and anatomical improvement; however, differences among the groups were not statistically significant. Patients treated with bevacizumab–triamcinolone had significantly higher IOPs at 4 weeks and 12 weeks (both *p* = 0.023 and 0.002, respectively) than bevacizumab alone.

Conclusion:

Single intravitreal bevacizumab effectively improved visual acuity and reduced central macular thickness with a favourable safety profile. Although combination therapy showed numerically greater anatomical and functional improvement, differences were not statistically significant. However, it significantly increased intraocular pressure, necessitating careful patient selection and regular intraocular pressure monitoring.