Suprachoroidal injection of triamcinolone acetonide plus intravitreal bevacizumab in diabetic macular edema: a randomized pilot trial

BackgroundTo investigate the efficacy of injecting suprachoroidal triamcinolone acetonide (SCTA) plus intravitreal bevacizumab (IVB) into patients with center-involving diabetic macular edema (CI-DME).MethodsIn this phase 2/3 randomized controlled pilot trial, sixty-six eyes with CI-DME and best-corrected visual acuity (BCVA) of at most 20/50 Snellen chart were randomly assigned into two groups. Monotherapy arm received sham injection plus 3 monthly IVB doses and combination arm received a single dose of SCTA and 3 monthly IVB doses. The mean improvements in BCVA and Central subfield thickness (CST), over the three-month was considered the main efficacy outcomes.ResultsThe mean BCVA improvements were obtained respectively as - 0.20 +/- 0.20 log [minimum angle of resolution (MAR)] (P = 0.004) and 0.37 +/- 0.24 log MAR (P < 0.001) in monotherapy and combination arms [between-group analysis (P = 0.014)]. Significant improvements were also observed in CST (P = 0.019) in the combination arm compared to the other. No adverse events (elevated intraocular pressure, cataract) were observed in any of the study arms.ConclusionSignificant improvements in BCVA and retinal anatomical outcomes demonstrated the additive effects of SCTA to those of anti-vascular endothelial growth factors with no short-term side effects and this combination appears to be a promising option in the management of patients with CI-DME.

Automated summary

This study investigated the efficacy of combining suprachoroidal triamcinolone acetonide (SCTA) with intravitreal bevacizumab (IVB) in patients with center-involving diabetic macular edema (CI-DME). The results showed that the combination of SCTA and IVB had significant improvements in both visual acuity and retinal thickness, with no significant side effects observed.