First-Line Treatment of Bulky Diabetic Macular Edema: Intravitreal Triamcinolone vs. Bevacizumab in a Randomized Clinical Trial

Author : Alireza Ramezani, Alireza Zare Mehrjardi, Pantea karbasi, Homayoun Nikkhah, Morteza Entezari, Hamid Safi

Abstract :Purpose: To compare the effectiveness of intravitreal injection of triamcinolone acetonide (IVT) versus bevacizumab (IVB) as first-line therapies for bulky diabetic macular edema (DME), defined as central macular thickness (CMT) ≥ 500 microns. Methods: In this randomized clinical trial, patients with bulky DME and best-corrected visual acuity (BCVA) between 20/40 and 20/400 were divided into two groups. The IVT group received 2 mg IVT monthly until CMT fell below 500 microns, after which treatment switched to 1.25 mg IVB monthly. The IVB group received 1.25 mg IVB from the start. BCVA and CMT were assessed monthly for six months by masked examiners. Results: Both treatments significantly improved CMT and BCVA. IVT led to a more rapid decrease in CMT, reaching 409.0 µm within the first month (P=0.001) and stabilizing at 409.7 µm by month six. The IVB group showed a gradual decline, reaching 413.4 µm at six months (P=0.000). In terms of visual acuity, IVT resulted in more rapid and significant improvement (from 0.81 to 0.51 logMAR, P=0.000) compared to IVB (from 0.85 to 0.71 logMAR, P=0.008). However, the IVT group experienced more steroid-related side effects, including elevated intraocular pressure and cataract progression. No significant difference in both final CMT and BCVA outcomes was observed between groups (P=0.927).

Keywords :Bulky DME, Intravitreal Injection, Triamcinolone, Bevacizumab

Conference Name :International Conference on Diabetes, Metabolic Syndrome and Obesity (ICDMSO-25)

Conference Place Budapest, Hungary

Conference Date 17th Mar 2025