Duration 5min, Q&A 3min
Comparison of Outcomes in the Use of Intravitreal Bevacizumab Vs. Triamcinolone for Patients with Diabetic Macular Edema at the Time of Cataract Surgery (The DiMECAT Trial)
Cataract surgery in diabetic patients often results in poor visual outcomes due to progression of diabetic retinopathy and accelerated development of Diabetic Macular Edema (DME). This study compares the use of intravitreal bevacizumab (BVB, AvastinTM) vs triamcinolone (TA, TriesenceTM) administered at the time of cataract surgery on the final visual and anatomical outcome.
Prospective randomized trial of intravitreal injection of either 1.25mg of BVB or 4mg of TA at the time of cataract surgery, and at subsequent review if required, in diabetics with visually significant cataract and one of the following: i) refractory DME at the time of surgery, ii) treated DME within the 12 months prior to surgery, or iii) microaneurysms within the foveal avascular zone not amenable to focal laser. End points included best-corrected visual acuity (BCVA, LogMAR letters), central macular thickness (CMT) on SD-OCT, number of injections and ocular complications at months 1,3 and 6 post-operatively.
To date, 40 patients have been recruited at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 25 of whom have had surgery (13 BVB,12 TA).
Men outnumbered women in both the BVB (n=7) and TA (n=11) groups, with a mean age of 68 and 64 years respectively (p =0.1703). At baseline, the BVB group with 59 LogMAR letters and CMT of 373um, was similar to the TA group with 50 LogMAR letters and CMT 384um (p=0.198 and 0.423 respectively).
Results and Conclusion
Eleven TA and 7 BVB subjects have currently reached the 3-month post-operative timepoint, where the TA group gained a mean of 24 letters in BCVA from baseline and the BVB group gained a mean of 16 letters - however the difference in gain between these 2 groups was not significant (p=0.470). Although the TA group had a better CMT than the BVB group at this timepoint (325um TA vs. 411um BVB, p=0.023), BCVA was found to be similar (73 letters TA vs. 76 letters BVB, p=0.610).
An average of 3.8 injections were given to the BVB group over 6 months, whilst one repeat TA injection was given at month 5. One subject experienced raised intraocular pressure in the TA group, with no other adverse events recorded.
Conclusions: When administered at the time of cataract surgery in patients with DME, interim results suggest that at 3 months, the TA group maintained a greater reduction in CMT than the BVB group from baseline. Further long term data is still pending.
[ Keyword ]
Diabetic macular oedema / Cataract Surgery / Intravitreal Bevacizumab / Intravitreal Triamcinolone / Visual Outcome
[ Conflict of Interest ]