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

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.