Revisiting the Role of Intravitreal Triamcinolone in Diabetic Macular Edema: 12-Month Outcomes after Bevacizumab Failure.

IF 2.6 3区医学 Q2 OPHTHALMOLOGY

Ophthalmology and Therapy Pub Date : 2025-06-07 DOI:10.1007/s40123-025-01172-5

Sukhum Silpa-Archa, Variya Nganthavee, Peranut Chotcomwongse, Pawas Lalitwongsa, Paisan Ruamviboonsuk

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引用次数: 0

Abstract

Introduction: Refractory diabetic macular edema (DME) is challenging in resource-limited settings, where costly alternatives such as non-bevacizumab anti-vascular endothelial growth factors (VEGFs) and corticosteroid implants are inaccessible. In Thailand, budget constraints exclude these drugs from healthcare schemes covering 92% of the population, a common issue in developing Asian countries. Therefore, this study aimed to evaluate the treatment outcome of repeated intravitreal triamcinolone acetonide (IVTA) dosages for DME refractory to intravitreal bevacizumab over a 12-month period using a decision algorithm.

Methods: This was a comparative retrospective study. The included patients were randomly divided into two groups that received either 2 mg or 4 mg IVTA, following a decision algorithm. The primary outcome was the difference in central macular thickness (CMT) between the 2 mg IVTA and 4 mg IVTA groups at 6-month and 12-month follow-up visits.

Results: Overall, 81 eyes (62 patients) with DME refractory to bevacizumab were enrolled. The study involved 53 eyes (37 cases) divided into two groups: group 1 (2 mg IVTA) of 14 eyes, and group 2 (4 mg IVTA) of 39 eyes. The 4 mg IVTA group had a higher initial CMT than their 2 mg IVTA counterparts (P = 0.02). This difference disappeared after 6 and 12 months. The improvement in CMT in both groups was maintained across the 6- and 12-month follow-up periods compared with baseline. Univariate logistic regression analysis revealed that patients with thinner CMT before IVTA treatment had a greater probability of being DME-free over long-term follow-up.

Conclusions: Repeated IVTA treatments for DME refractory to bevacizumab over a 12-month period demonstrated efficacy and appeared to have a comparable safety profile. Patients with thinner CMT before IVTA treatment had a greater probability of remaining DME-free after IVTA treatment.

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重新审视玻璃体内曲安奈德在糖尿病黄斑水肿中的作用：贝伐单抗失败后12个月的结果。

难治性糖尿病黄斑水肿（DME）在资源有限的环境中具有挑战性，在这些环境中，非贝伐单抗抗血管内皮生长因子（vegf）和皮质类固醇植入物等昂贵的替代品难以获得。在泰国，预算限制将这些药物排除在覆盖92%人口的医疗保健计划之外，这是亚洲发展中国家的一个普遍问题。因此，本研究旨在使用决策算法评估在12个月的时间内，玻璃体内贝伐单抗难治性二甲醚的反复注射曲安奈德（IVTA）治疗效果。方法：采用比较回顾性研究。纳入的患者根据决策算法随机分为两组，分别接受2mg或4mg IVTA治疗。主要结果是2 mg IVTA组和4 mg IVTA组在6个月和12个月随访时黄斑中央厚度（CMT）的差异。结果：总的来说，81只眼（62例患者）的DME对贝伐单抗难治性纳入研究。该研究涉及53只眼睛（37例），分为两组：1组（2 mg IVTA） 14只眼睛，2组（4 mg IVTA） 39只眼睛。4 mg IVTA组的初始CMT高于2 mg IVTA组（P = 0.02）。这种差异在6个月和12个月后消失。与基线相比，两组在6个月和12个月的随访期间均保持了CMT的改善。单因素logistic回归分析显示，IVTA治疗前CMT较薄的患者在长期随访中无dme的可能性更大。结论：对于贝伐单抗难治性二甲醚，在12个月的时间内反复IVTA治疗显示出疗效，并且似乎具有相当的安全性。在IVTA治疗前CMT较薄的患者在IVTA治疗后保持无dme的可能性更大。

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来源期刊

Ophthalmology and Therapy OPHTHALMOLOGY-

CiteScore

4.20

自引率

3.00%

发文量

157

审稿时长

6 weeks

期刊介绍： Aims and Scope Ophthalmology and Therapy is an international, open access, peer-reviewed (single-blind), and rapid publication journal. The scope of the journal is broad and will consider all scientifically sound research from preclinical, clinical (all phases), observational, real-world, and health outcomes research around the use of ophthalmological therapies, devices, and surgical techniques. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/series, trial protocols and short communications such as commentaries and editorials. Ophthalmology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. Rapid Publication The journal’s publication timelines aim for a rapid peer review of 2 weeks. If an article is accepted it will be published 3–4 weeks from acceptance. The rapid timelines are achieved through the combination of a dedicated in-house editorial team, who manage article workflow, and an extensive Editorial and Advisory Board who assist with peer review. This allows the journal to support the rapid dissemination of research, whilst still providing robust peer review. Combined with the journal’s open access model this allows for the rapid, efficient communication of the latest research and reviews, fostering the advancement of ophthalmic therapies. Open Access All articles published by Ophthalmology and Therapy are open access. 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