Management of Diabetic Macular Edema using Intravitreal Bevacizumab versus Intravitreal Triamcinolone: Systematic Review and Meta-Analysis

Background and aim: Triamcinolone, as an ocular steroid, plays an anti-inflammatory, anti-angiogenic, and cost-effective role in the treatment of DME. Meanwhile, the humanized monoclonal antibody bevacizumab shows promising anti-VEGF results when used as an off-label therapeutic option because it is less expensive than most anti-VEGF agents. This work aims to determine the efficacy and safety of Intravitreal Bevacizumab (IVB), versus Intravitreal Triamcinolone (IVT) in Diabetic Macular Edema (DME) patients. Methodology: A systematic search was performed over different medical databases to identify ophthalmology studies, which studied the outcome of the IVB group versus the IVT group of DME patients. We conducted a meta-analysis process on Best-Corrected Visual Acuity (BCVA) and Central Macular Thickness (CMT), as primary outcomes, and on Intraocular Pressure (IOP) as a secondary outcome. Eight studies were identified involving 564 eyes, 285 in the IVB group, and 279 in the IVT group. Our meta-analysis process showed a highly significant decrease in mean CMT in the IVB group compared to the IVT group (p=0.043). But, there was a non-significant difference in mean BCVA and IOP between groups (p>0.05) respectively. Conclusion: To conclude, this study compares the efficacy and safety of Intravitreal Bevacizumab (IVB), versus Intravitreal Triamcinolone (IVT) in Diabetic Macular Edema, according to our results IVB was more effective than IVT in CRT reduction but no difference between both in best-corrected visual acuity and on Intraocular Pressure (IOP) parameters.