Comparative Effectiveness of Intravitreal Bevacizumab With or Without Triamcinolone Acetonide for Treatment of Diabetic Macular Edema

Background: Bevacizumab and triamcinolone acetonide (TA) are both common choices for treatment of diabetic macular edema (DME), but the comparative efficacy of combined or separate applications is still not determined. Objectives: To compare the treatment efficacy of intravitreal bevacizumab (IVB) and the combination of IVB and intravitreal triamcinolone (IVT) for DME patients. Methods: Pub Med, EMBASE, and the Cochrane library were systematically reviewed for randomized controlled trials comparing IVB with IVB/IVT. Data on visual acuity (VA) and central macular thickness (CMT) changes at 3 and 6 months were extracted and data on adverse events were collected. A meta-analysis was performed using the software Rev Man 5.3. The methodological quality and bias risks were also evaluated. Results: VA improved more significantly in the IVB/IVT group compared with the IVB group at 3 months (mean difference [MD] = 0.07; 95% Cl = 0.01 to 0.13), whereas there was no significant difference at 6 months (MD = 0.01; 95%Cl = -0.11 to 0.09). The CMT reduction in the IVB/IVT group was significantly greater than that in the IVB group at 3 months (MD = 48.40; 95%Cl = 30.23 to 66.57), but no statistically significant difference was found at 6 months (MD = 0.47; 95%Cl = -24.11 to 25.04). Ocular hypertension was detected in 9/243 eyes in the IVB/IVT group but none of the IVB eyes. Conclusion: IVB/IVT is more effective for improving VA and decreasing CMT at 3 months in DME. A single injection of TA along with the first IVB could improve outcome within 3 months, but this is not sustained at 6 months. Continuous IVT/IVB treatment should be performed in further trials to clarify its long-term potential efficacy.