Role of Combining Suprachoroidal Triamcinolone with Intravitreal Bevacizumab on Refractory Diabetic Macular Edema

Doi: 10.36351/pjo.v42i4.2244

Abstract

Purpose:  To evaluate the effectiveness and safety of combination therapy using suprachoroidal triamcinolone acetonide (TA) and intravitreal bevacizumab in patients with refractory diabetic macular edema (DME). Study Design:  Interventional case series. Place and Duration of Study:  Ibrahim Eye Center, from   December 2024 to September 2025. Methods:  This interventional case series included ten eyes with refractory DME that remained unresponsive despite receiving at least three previous intravitreal anti-VEGF injections. All patients received a single session of combination therapy consisting of intravitreal bevacizumab (1.25 mg/0.05 mL) and suprachoroidal triamcinolone acetonide (4 mg/0.1 mL). Central subfield thickness (CST) was measured using optical coherence tomography (OCT) at baseline and eight weeks after treatment. Changes in CST and treatment-related adverse events were evaluated. Results:  There were 5 males and 5 females, all with uncontrolled type II diabetes mellitus (HbA1c >6.5%). The duration of diabetes ranged from 12 to 17 years, with a mean of 14.3±2.7 years. Mean CST decreased significantly from 667.5±150 µm at baseline to 363.4±150.22µm at eight weeks following treatment (p = 0.006). Eight eyes (80%) achieved a reduction in CST of at least 50µm. No serious ocular or systemic adverse events were observed. A transient rise in intraocular pressure occurred in two patients and was successfully controlled with topical anti-glaucoma medication. Conclusion:  Combination therapy with suprachoroidal triamcinolone acetonide and intravitreal bevacizumab produced significant anatomical improvement in refractory DME with a favorable safety profile.