Sydney Eye Hospital, Sydney, New South Wales, Australia.
Clin Exp Ophthalmol. 2011 Sep-Oct;39(7):673-81. doi: 10.1111/j.1442-9071.2011.02504.x. Epub 2011 Mar 24.
BACKGROUND: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. DESIGN: Prospective, non-randomized, masked, interventional case series. PARTICIPANTS: Twenty-four eyes of 24 subjects with centre-involved diabetic macular oedema extending over two disc-areas with predominant cystic changes on spectral domain optical coherence tomography were selected. METHODS: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. MAIN OUTCOME MEASURES: Change in central macular volume on spectral domain optical coherence tomography and best-corrected visual acuity were measured at 6-week follow-up. RESULTS: Baseline data were matched in both groups. Post-injection central macular volume (7.46 ± 0.73 mm(3)) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre-injection central macular volume (9.11 ± 1.0 mm(3)) or when compared with the post-injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm(3)). However, post-injection best-corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best-corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre-injection central macular volume (r = 0.55, P = 0.005). CONCLUSIONS: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best-corrected visual acuity.
背景：比较单次玻璃体内注射联合曲安奈德和贝伐单抗（阿瓦斯汀）与玻璃体内曲安奈德治疗弥漫性囊样糖尿病黄斑水肿的疗效。
设计：前瞻性、非随机、盲法、干预性病例系列研究。
参与者：选择 24 例中心受累的糖尿病黄斑水肿患者的 24 只眼，这些患者的光谱域光学相干断层扫描显示两个视盘区域有广泛的囊样改变。
方法：10 例未行白内障手术的眼和 2 例已行白内障手术的眼接受玻璃体内注射曲安奈德和贝伐单抗，而 12 例已行白内障手术的眼和 2 例已行白内障手术的眼接受玻璃体内注射曲安奈德。
主要观察指标：在 6 周随访时，用光谱域光学相干断层扫描测量中心黄斑体积的变化和最佳矫正视力。
结果：两组的基线数据相匹配。与玻璃体内曲安奈德注射前的黄斑中心体积（9.11 ± 1.0mm3）相比，玻璃体内曲安奈德注射后（7.46 ± 0.73mm3），玻璃体内曲安奈德组的黄斑中心体积明显降低（P < 0.001），并且与玻璃体内曲安奈德和贝伐单抗组（8.42 ± 1.18mm3）注射后的黄斑中心体积相比也明显降低（P = 0.02）。然而，在 6 周时，玻璃体内曲安奈德组（0.65 ± 0.15 logMAR）和玻璃体内曲安奈德和贝伐单抗组（0.685 ± 0.15 logMAR）的最佳矫正视力后，两组间的最佳矫正视力后差异无统计学意义（P = 0.06）。从两组的综合数据来看，黄斑中心体积的变化与最佳矫正视力的变化之间没有明显的相关性（r = 0.35，P = 0.07）。黄斑中心体积的变化与注射前的黄斑中心体积有很好的相关性（r = 0.55，P = 0.005）。
结论：玻璃体内曲安奈德治疗弥漫性囊样糖尿病黄斑水肿可能比玻璃体内曲安奈德和贝伐单抗更有效，可以减少黄斑体积。黄斑体积的显著减少并不一定转化为最佳矫正视力的相应显著提高。
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