Intravitreal triamcinolone versus intravitreal bevacizumab for diabetic macular edema:a meta-analysis

AIM: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).·METHODS: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 5.1.0was used to do the meta-analysis.Heterogeneity was determined and sensitivity was conducted.·RESULTS: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 3months) 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).·CONCLUSION:Current evidence shows IVT is superior in improving VA at earlier follow-up(1 month and 3months) and in reducing CMT at later follow-up(6months) 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.