Yaseen Lodhi, Adnan Aslam Saleem, Danish Gani, Nadeem Qureshi.
Comparison of efficacy of intravitreal avastin alone with combination of intraviteal avastin and peribulbar triamcinolone in diabetic macular edema.
Al-Shifa J Ophthalmol Jan ;12(1):9-15.

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 debatable. Purpose: To compare the efficacy of intravitreal injection avastin alone with combined intravitreal injection of avastin and peribulbar triamcinolone/ posterior sub tenonkenacort (PSTK) in patients of diabetic macular edema. Methods: The study was carried out in the vitreoretina department of Al-Shifa Trust Eye Hospital, Rawalpindi.Main outcome measure was improvement in number of Snellen visual acuity lines one month after treatment in this randomized clinical trial. Results: Thirty five patients were studied in both groups. All but 2 patients completed the follow-up. At baseline mean BCVA ±SD was 0.8712± 0.28685 log MAR of Snellen letters in the avastin alone group. In avastin + PSTK group, baseline mean BCVA ±SD was 0.8371 ± 0.33267 log MAR of Snellen letters. The follow up BCVA ±SD was 0.5541±0.31255 in the avastin only group compared to 0.5406 ± 0.31255 in the avastin + PSTK group. This shows significant improvement in visual acuity (p-value < 0.001) in their respective groups. When comparing both groups using the independent t-test, the p-value came out to be 0.790, showing there is no significant difference in VA improvement when subtenon triamcinolone is added to intravitreal avastin. Conclusion: Intravitreal bevacizumab injection alone in a concentration of 1.25mg / 0.05ml in patients with DME resulted in significant improvement in BCVA. Intravitreal avastin when given with posterior subtenon triamcinolone in a dosage of 4mg/.1 ml (40mg/ml) also showed significant improvement in BCVA but this improvement was not statistically significant. Al-Shifa Journal of Ophthalmology

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