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The effect of combined treatment of bevacizumab and triamcinolone for diabetic macular edema refractory to previous intravitreal mono-injections

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Abstract

The purpose of this study is to evaluate the efficiency of combined treatment of bevacizumab and triamcinolone in refractory diffuse DME (DDME). Twenty-five pseudophakic eyes with DDME refractory to previous successive intravitreal bevacizumab (IVB, 1.25 and 2.5 mg/0.1 ml) and triamcinolone (IVT, 4 mg and 10 mg/0.1 ml) injections were included. The average number of injections was two (1–4). The mean best corrected visual acuity (BCVA) was 0.8 (0.3–1.5) logMAR before enrollment, 0.6 (0.0–1.5) logMAR at 6 months and 0.6 (0–1.8) logMAR at 12 months (p = 0.0001, p = 0.003). The median central macular thickness (CMT) of all the eyes was 575 (502–1049) µm at baseline, 370 (179–983) µm at 6 months, and 410 (198–929) µm at 12 months (p = 0.0001; p = 0.0001). At 6 months, the VA of 13 (52 %) patients was stabilized (± 0.2 logMAR of initial BCVA) and 12 (48 %) patients showed visual improvement (>0.2 logMAR). At 12 months, 10 (40 %) patients had stabilized vision, 13 (52 %) showed visual improvement and 2 (8 %) showed visual loss. At 6 months, 18 (72 %) patients showed anatomic stabilization (a decrease of 10 % to 50 % in initial CMT) and 7 (28 %) anatomical success (a decrease in CMT more than 50 % or ≤250 µm at final visit). At 12 months, 13 (52 %) patients showed anatomic stabilization, 10 (40 %) anatomic success, and 2 (8 %) anatomical failure (decrease in CMT less than 10 %). The combined application of IVB and triamcinolone may improve vision and decrease CMT in severe DDME cases refractory to previous monotherapies.

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References

  1. Ciulla TA, Amador AG, Zinman B (2003) Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care 26:2653–2664

    Article  PubMed  Google Scholar 

  2. Petroll WM, Boettcher K, Barry P, Cavanagh HD, Jester JV (1995) Quantitative assessment of anteroposterior keratocyte density in the normal rabbit cornea. Cornea 14:3–9

    Article  CAS  PubMed  Google Scholar 

  3. Massin P, Bandello F, Garweg JG, Hansen LL, Harding SP, Larsen M et al (2010) Safety and efficacy of ranibizumab in diabetic macular edema (RESOLVE Study): a 12-month, randomized, controlled, double-masked, multicenter phase II study. Diabetes Care 33:2399–2405

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Michaelides M, Kaines A, Hamilton RD, Fraser-Bell S, Rajendram R, Quhill F et al (2010) A prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (BOLT study) 12-month data: report 2. Ophthalmology 117(1078–86):e2

    PubMed  Google Scholar 

  5. Yilmaz T, Cordero-Coma M, Gallagher MJ, Teasley LA (2011) Systematic review of intravitreal bevacizumab injection for treatment of primary diabetic macular oedema. Acta Ophthalmol 89:709–717

    Article  CAS  PubMed  Google Scholar 

  6. Koss MJ, Naser H, Sener A, Ackermann H, Al-Sarireh F, Singh P et al (2012) Combination therapy in diabetic macular oedema and retinal vein occlusion—past and present. Acta Ophthalmol 90:580–589

    Article  PubMed  Google Scholar 

  7. Jaissle GB, Szurman P, Bartz-Schmidt KU (2005) [Recommendation for the implementation of intravitreal injections—statement of the German Retina Society, the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. Klinische Monatsblatter fur Augenheilkunde. 222:390–395. Empfehlung fur die Durchfuhrung von intravitrealen Injektionen—Stellungnahme der Retinologischen Gesellschaft, der Deutschen Ophthalmologischen Gesellschaft (DOG) und des Berufsverbands der Augenarzte Deutschland (BVA)

  8. Sobaci G, Ozge G, Erdurman C, Durukan HA, Bayraktar ZM (2012) Comparison of grid laser, intravitreal triamcinolone, and intravitreal bevacizumab in the treatment of diffuse diabetic macular edema. Ophthalmol J Int Ophtalmol (Int J Ophthalmol) (Zeitschrift fur Augenheilkunde) 227:95–99

    Article  CAS  Google Scholar 

  9. Fong DS, Strauber SF, Aiello LP, Beck RW, Callanan DG, Danis RP et al (2007) Comparison of the modified early treatment diabetic retinopathy study and mild macular grid laser photocoagulation strategies for diabetic macular edema. Arch Ophthalmol 125:469–480

    Article  PubMed  Google Scholar 

  10. Kosobucki BR, Freeman WR, Cheng L (2006) Photographic estimation of the duration of high dose intravitreal triamcinolone in the vitrectomised eye. Br J Ophthalmol 90:705–708

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Cheng L, Banker AS, Martin M, Kozak I, Freeman WR (2009) Triamcinolone acetonide concentration of aqueous humor after decanted 20-mg intravitreal injection. Ophthalmology 116:1356–1359

    Article  PubMed  Google Scholar 

  12. Arevalo JF, Sanchez JG, Fromow-Guerra J, Wu L, Berrocal MH, Farah ME et al (2009) Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up. Graefe’s Arch Clin Experim Ophthalmol (Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie) 247:735–743

    Article  CAS  Google Scholar 

  13. Goyal S, Lavalley M, Subramanian ML (2011) Meta-analysis and review on the effect of bevacizumab in diabetic macular edema. Graefe’s Arch Clin Experim Ophthalmol (Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie) 249:15–27

    Article  CAS  Google Scholar 

  14. Mitchell P, Bandello F, Schmidt-Erfurth U, Lang GE, Massin P, Schlingemann RO et al (2011) The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology 118:615–625

    Article  PubMed  Google Scholar 

  15. Soheilian M, Ramezani A, Obudi A, Bijanzadeh B, Salehipour M, Yaseri M et al (2009) Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema. Ophthalmology 116:1142–1150

    Article  PubMed  Google Scholar 

  16. Tsilimbaris MK, Pandeleondidis V, Panagiototglou T, Arvanitaki V, Fragiskou S, Eleftheriadou M et al (2009) Intravitreal combination of triamcinolone acetonide and bevacizumab (Kenacort–Avastin) in diffuse diabetic macular edema. Semin Ophthalmol 24:225–230

    Article  PubMed  Google Scholar 

  17. Wang YS, Li X, Wang HY, Zhang ZF, Li MH, Su XN (2011) Intravitreal bevacizumab combined with/without triamcinolone acetonide in single injection for treatment of diabetic macular edema. Chin Med J 124:352–358

    CAS  PubMed  Google Scholar 

  18. Schmidt-Erfurth U, Lang GE, Holz FG, Schlingemann RO, Lanzetta P, Massin P et al (2014) Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study. Ophthalmology 121:1045–1053

  19. Hauser D, Bukelman A, Pokroy R, Katz H, Len A, Thein R et al (2008) Intravitreal triamcinolone for diabetic macular edema: comparison of 1, 2, and 4 mg. Retina 28:825–830

    Article  PubMed  Google Scholar 

  20. Folgosa MS, Messias A, Takata C, Costa RA, Scott IU, Jorge R (2010) Single intravitreal injection of triamcinolone combined with bevacizumab for the treatment of diffuse diabetic macular oedema refractory to grid photocoagulation. Acta Ophthalmol 88:e297–e298

    Article  PubMed  Google Scholar 

  21. Brooks HL Jr, Caballero S Jr, Newell CK, Steinmetz RL, Watson D, Segal MS et al (2004) Vitreous levels of vascular endothelial growth factor and stromal-derived factor 1 in patients with diabetic retinopathy and cystoid macular edema before and after intraocular injection of triamcinolone. Arch Ophthalmol 122:1801–1807

    Article  CAS  PubMed  Google Scholar 

  22. Matsuyama K, Ogata N, Jo N, Shima C, Matsuoka M, Matsumura M (2009) Levels of vascular endothelial growth factor and pigment epithelium-derived factor in eyes before and after intravitreal injection of bevacizumab. Jpn J Ophthalmol 53:243–248

    Article  CAS  PubMed  Google Scholar 

  23. Sohn HJ, Han DH, Kim IT, Oh IK, Kim KH, Lee DY et al (2011) Changes in aqueous concentrations of various cytokines after intravitreal triamcinolone versus bevacizumab for diabetic macular edema. Am J Ophthalmol 152:686–694

    Article  CAS  PubMed  Google Scholar 

  24. Jonas JB, Libondi T, Golubkina L, Spandau UH, Schlichtenbrede F, Rensch F (2010) Combined intravitreal bevacizumab and triamcinolone in exudative age-related macular degeneration. Acta Ophthalmol 88:630–634

    Article  CAS  PubMed  Google Scholar 

  25. Schaal S, Kaplan HJ, Tezel TH (2008) Is there tachyphylaxis to intravitreal anti-vascular endothelial growth factor pharmacotherapy in age-related macular degeneration? Ophthalmology 115:2199–2205

    Article  PubMed  Google Scholar 

  26. Nguyen QD, Brown DM, Marcus DM, Boyer DS, Patel S, Feiner L et al (2012) Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: rISE and RIDE. Ophthalmology 119:789–801

    Article  PubMed  Google Scholar 

  27. Wang H, Sun X, Liu K, Xu X (2012) Intravitreal ranibizumab (lucentis) for the treatment of diabetic macular edema: a systematic review and meta-analysis of randomized clinical control trials. Curr Eye Res 37:661–670

    Article  CAS  PubMed  Google Scholar 

  28. Ford JA, Elders A, Shyangdan D, Royle P, Waugh N (2012) The relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema: an indirect comparison in a systematic review. BMJ 345:e5182

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, GATA (Gulhane Military Medical Academy and Medical School), Ankara, Turkey

    Ümit Yolcu & Güngör Sobaci

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  1. Ümit Yolcu
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  2. Güngör Sobaci
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Correspondence to Ümit Yolcu.

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Yolcu, Ü., Sobaci, G. The effect of combined treatment of bevacizumab and triamcinolone for diabetic macular edema refractory to previous intravitreal mono-injections. Int Ophthalmol 35, 73–79 (2015). https://doi.org/10.1007/s10792-014-0019-5

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  • DOI: https://doi.org/10.1007/s10792-014-0019-5

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