Jin Enzhong, Luo Ling, Bai Yujing, Zhao Mingwei
Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People's Hospital, Beijing, People's Republic of China.
The 306th Hospital of PLA, Beijing, People's Republic of China.
Ann Pharmacother. 2015 Apr;49(4):387-97. doi: 10.1177/1060028014568006. Epub 2015 Jan 26.
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 not determined.
To compare the treatment efficacy of intravitreal bevacizumab (IVB) and the combination of IVB and intravitreal triamcinolone (IVT) for DME patients.
PubMed, EMBASE, and the Cochrane library were systematically reviewed for randomized controlled trials comparing IVB with IVB/IVT. Data on visual acuity (VA) and central macular thickness (CMT) changes at 3 and 6 months were extracted and data on adverse events were collected. A meta-analysis was performed using the software RevMan 5.3. The methodological quality and bias risks were also evaluated.
VA improved more significantly in the IVB/IVT group compared with the IVB group at 3 months (mean difference [MD] = 0.07; 95% CI = 0.01 to 0.13), whereas there was no significant difference at 6 months (MD = -0.01; 95%CI = -0.11 to 0.09). The CMT reduction in the IVB/IVT group was significantly greater than that in the IVB group at 3 months (MD = 48.40; 95%CI = 30.23 to 66.57), but no statistically significant difference was found at 6 months (MD = 0.47; 95%CI = -24.11 to 25.04). Ocular hypertension was detected in 9/243 eyes in the IVB/IVT group but none of the IVB eyes.
IVB/IVT is more effective for improving VA and decreasing CMT at 3 months in DME. A single injection of TA along with the first IVB could improve outcome within 3 months, but this is not sustained at 6 months. Continuous IVT/IVB treatment should be performed in further trials to clarify its long-term potential efficacy.
贝伐单抗和曲安奈德（TA）都是治疗糖尿病性黄斑水肿（DME）的常用药物，但联合应用或单独应用的相对疗效仍未确定。
比较玻璃体内注射贝伐单抗（IVB）以及IVB与玻璃体内注射曲安奈德（IVT）联合应用对DME患者的治疗效果。
系统检索PubMed、EMBASE和Cochrane图书馆，查找比较IVB与IVB/IVT的随机对照试验。提取3个月和6个月时视力（VA）和中心黄斑厚度（CMT）变化的数据，并收集不良事件的数据。使用RevMan 5.3软件进行荟萃分析。还评估了方法学质量和偏倚风险。
在3个月时，IVB/IVT组的VA改善比IVB组更显著（平均差[MD]=0.07；95%可信区间[CI]=0.01至0.13）；而在6个月时无显著差异（MD=-0.01；95%CI=-0.11至0.09）。IVB/IVT组在3个月时CMT的降低显著大于IVB组（MD=48.40；95%CI=30.23至66.57），但在6个月时未发现统计学显著差异（MD=0.47；95%CI=-24.11至25.04）。IVB/IVT组243只眼中有9只检测到高眼压，而IVB组未检测到。
IVB/IVT在3个月时对改善DME患者的VA和降低CMT更有效。首次IVB注射时联合单次注射TA可在3个月内改善疗效，但在6个月时这种效果未持续。应在进一步试验中进行持续的IVT/IVB治疗，以阐明其长期潜在疗效。
