Clinical Efficacy and Adverse Effects of Intravitreal Triamcinolone Acetonide versus Bevacizumab on Macular Thickness and Visual Acuity in Patients with Diabetic Macular Edema

Methods: In this prospective, randomized, comparative interventional study, 60 eyes of patients with center-involving DME were randomly allocated in a 1:1 ratio to receive either 4 mg/0.1 mL IVTA (n = 30) or 1.25 mg/0.05 mL IVB (n = 30). CMT was measured by spectral-domain optical coherence tomography (SD-OCT) and BCVA was recorded on the logarithm of the minimum angle of resolution (logMAR) scale using Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Intraocular pressure (IOP), lens status, and injection-related complications were monitored at baseline and at weeks 4, 12, and 24. Retreatment was permitted according to predefined criteria.
Results: Both agents produced significant reductions in CMT and improvements in BCVA from baseline (P < 0.001). CMT reduction was significantly greater in the IVTA group at week 4 (P = 0.04), but the difference was no longer significant at weeks 12 and 24. BCVA improvement was comparable early, but at week 24 was significantly better in the IVB group (P = 0.048). Elevated IOP and cataract progression were significantly more frequent in the IVTA group, whereas the IVB group required a greater number of injections.
Conclusion: IVTA offers a faster, more pronounced early anatomical response, but IVB provides superior sustained visual outcomes with a substantially safer ocular adverse-effect profile. Bevacizumab remains a suitable first-line agent, while triamcinolone retains a role in selected pseudophakic, refractory, or non-adherent patients.