Suprachoroidal Triamcinolone Plus Intravitreal Bevacizumab Versus Bevacizumab Alone for Diabetic Macular Edema in Pseudophakic Eyes: A randomized controlled trial

Abstract

Objective: To determine the efficacy of intravitreal bevacizumab (IVB) monotherapy versus a combination of IVB and suprachoroidal triamcinolone acetonide (SCTA) followed by monthly IVB in pseudophakic eyes with center-involving diabetic macular edema (DME).

Methodology: The Ophthalmology Department of Khyber Teaching Hospital conducted this randomized controlled study between April 2023 to February 2024. Eighty-two pseudophakic patients with center-involving DME were randomly divided into two groups (41 each). The monotherapy group (Group-I) received a monthly injection of IVB (1.25mg/0.05 mL) for three months. The combination therapy group (Group-II) received combination of IVB (1.25 mg/0.05 mL) and SCTA (4 mg/0.1 mL) injections at first visit which were then followed by monthly IVB injection for next two months. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and at four months.

Results: Both groups showed statistically significant improvement in BCVA and CMT from baselines. In Group-I, BCVA improved from 0.90±0.31 to 0.69±0.31 (p<0.001), and CMT decreased from 385.12±68.51 µm to 329.22±55.70 µm (p<0.001). In Group-II, BCVA improved from 0.84±0.28 to 0.52±0.21 (p<0.001), while CMT decreased from 382.49±63.32 µm to 292.46±32.24 µm (p<0.001). When compared between the groups, Group-II showed statistically significant improvement both in BCVA (p=0.034) and CMT (p<0.001).

Conclusion: In pseudophakic patients with center-involving DME, a single combined treatment with SCTA and IVB yields better anatomical response and visual improvements as compared to IVB monotherapy. This combination approach might provide more therapeutic efficacy in terms of reducing macular edema.