Purpose: To compare the effects of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) injections for the treatment of diabetic macular edema (DME).
Methods: A literature search was conducted using PUBMED, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. Pooled mean differences (MDs) for changes in visual acuity (VA) and central macular thickness (CMT) were calculated between groups receiving a single TA (4 mg) and bevacizumab (1.25 or 1.5 mg) from baseline to 4, 8, 12 and 24 weeks after treatment, respectively. Changes in intraocular pressure (IOP) were calculated between the two groups from baseline to 4, 8 and 12 weeks after treatment.
Results: Eight trials (n = 434 eyes) comparing the efficacy of IVTA with IVB were included in the meta-analysis. Patients in the IVTA group demonstrated significant post-treatment improvement in VA compared with those in the IVB group at 4 (MD = -0.08; 95% confidence interval [CI]: -0.12 to -0.03; p = 0.0008), 8 (MD = -0.15; 95% CI: -0.20 to -0.11; p < 0.00001), 12 (MD = -0.11; 95% CI: -0.15 to -0.06; p < 0.0001) and 24 (MD = -0.05; 95% CI: -0.10 to -0.01; p = 0.02) weeks. After receiving IVTA, MDs in CMT decreased significantly at 4 weeks (MD = -40.05 μm; 95% CI: -75.29 to -4.81; p = 0.03). No significant differences in CMT were seen between the two groups at 8, 12 and 24 weeks post-treatment. Fluctuations of IOP were within normal range for both groups throughout the entire observation period.
Conclusions: Results of this meta-analysis suggest that IVTA is more effective for improving VA in DME. However, the CMT reduction with IVTA was unsustainable. Additional well-designed studies are needed to further investigate optimal interventions.