intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment for diabetic macular edema; an interim analysis

purpose: to report the efficacy of a single intravitreal injection of bevacizumab (ivb) alone or in com-bination with intravitreal triamcinolone acetonide (ivt) versus macular laser photocoagulation (mpc) as primary treatment for diabetic macular edema (dme). methods: this randomized three-arm clinical trial included 103 eyes of 97 patients with clinically significant dme and no previous treatment. the eyes were randomly assigned to one of the three study arms: the ivb group received 1.25 mg ivb (37 eyes), the ivb/ivt group received 1.25 mg ivb together with 2 mg ivt (33 eyes), and the mpc group underwent focal or modified grid laser photocoagulation (33 eyes). primary outcome measure was change in best-corrected visual acuity (bcva). results: changes in bcva (logmar) at 12 weeks were -0.22±0.23, -0.13±0.31 and +0.08±0.31 in the ivb, ivb/ivt and mpc groups, respectively. the marginal regression model based on generalized estimating equation analysis demonstrated that changes in visual acuity was statistically significant in the ivb group at both 6 (p<0.001) and 12 (p=0.024) weeks but only at 6 weeks in the ivb/ivt group. significant decrease in central macular thickness (cmt) was observed in the ivb and ivb/ivt groups at 6 weeks. conclusion: up to 12 weeks, ivb treatment in eyes with dme yielded better visual outcome than laser photocoagulation, although it was not associated with a significant decrease in cmt. ivt seemed to have no further beneficial effect in combination with ivb.