Zhang Xiao-Ling, Chen Jian, Zhang Ri-Jia, Wang Wen-Jie, Zhou Qing, Qin Xiao-Yan
Department of Ophthalmology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, Guangdong Province, China.
Int J Ophthalmol. 2013 Aug 18;6(4):546-52. doi: 10.3980/j.issn.2222-3959.2013.04.26. eCollection 2013.
To compare the efficacy of the sole intravitreal triamcinolone (IVT) versus intravitreal bevacizumab (IVB) alone or IVB combined with IVT in the treatment of diabetic macular edema (DME).
Pertinent publications were identified through systematic searches of database and manually searching. Methodological quality of the literatures was valuated according to the Jadad Score. RevMan 5.1.0 was used to do the meta-analysis. Heterogeneity was determined and sensitivity was conducted.
Six studies were ultimately included in the meta-analysis. The results of our analysis showed IVT had a statistically significant improvement in vision over the IVB at 1 month and 3 months (P<0.01). However, the reduction was not significant regarding central macular thickness (CMT) during the earlier (1 month and 3 months) follow-up period (P=0.12, P=0.41, respectively). At later visit (6 months), IVT had a significant decrease in CMT when compared to IVB (P<0.01) while no significant improvement in visual acuity (VA) was observed (P=0.14). The incidence of intraocular hypertension was 13/102 in IVT group during follow-up period while 0/103 in IVB group. The difference was significant (P<0.01). With regards to IVT versus IVB combined with IVT, there were no significant differences in CMT at 1 month (P=0.86) and 3 months (P=0.06). The incidence of intraocular hypertension was 6/67 in IVT group during follow-up period while 4/66 in IVB+IVT group. But the difference was not significant (P=0.53).
Current evidence shows IVT is superior in improving VA at earlier follow-up (1 month and 3 months) and in reducing CMT at later follow-up (6 months) for DME. At other time, it is in favor of IVT treatment but there are no statistically significances. However, IVT has the side-effect of ocular hypertension. There is no adequate evidence of the benefit adding IVB to IVT in contrast to IVT alone.
比较单纯玻璃体腔注射曲安奈德（IVT）、单纯玻璃体腔注射贝伐单抗（IVB）以及IVB联合IVT治疗糖尿病性黄斑水肿（DME）的疗效。
通过系统检索数据库和手工检索确定相关出版物。根据Jadad评分评估文献的方法学质量。使用RevMan 5.1.0进行荟萃分析。确定异质性并进行敏感性分析。
最终6项研究纳入荟萃分析。分析结果显示，在1个月和3个月时，IVT在视力改善方面比IVB有统计学显著改善（P<0.01）。然而，在早期（1个月和3个月）随访期间，中心黄斑厚度（CMT）的降低不显著（分别为P=0.12，P=0.41）。在后期随访（6个月）时，与IVB相比，IVT的CMT有显著降低（P<0.01），而视力（VA）未观察到显著改善（P=0.14）。随访期间，IVT组高眼压发生率为13/102，而IVB组为0/103。差异有统计学意义（P<0.01）。关于IVT与IVB联合IVT，在1个月（P=0.86）和3个月（P=0.06）时CMT无显著差异。随访期间，IVT组高眼压发生率为6/67，IVB+IVT组为4/66。但差异无统计学意义（P=0.53）。
目前证据表明，对于DME，IVT在早期随访（1个月和3个月）改善视力以及后期随访（6个月）降低CMT方面更具优势。在其他时间，更倾向于IVT治疗，但无统计学意义。然而，IVT有高眼压副作用。与单纯IVT相比，尚无充分证据表明IVB联合IVT有益。
