To compare the results of intravitreal Bevacizumab (IVB) injection alone or in combination with intravitreal 1mg triamcinolone acetonide (IVT).

In a randomized clinical trial, a total of 82 eyes of 41 patients with clinically significant DME and no previous treatment were participated in study. One of the eyes of each patient was randomly assigned to 1.25 mg of IVB injection alone and other to combination of 1.25 IVB and 1 mg IVT. Best corrected visual acuity (BCVA), Central macular thickness, intraocular pressure (IOP) and grading of lens opacity were evaluated at base line, 2 weeks, 4 weeks, 6 weeks, 12 weeks and 24 weeks after treatment. Retreatment was performed at 6-week intervals whenever indicated based on central macular thickness (CMT).

BCVA changes among the groups were not statistically significant until 12 weeks follow up (P>0.05) but at 24 weeks after treatment were significantly better in IVB group (p=0.049). BCVA improvement within each group was significant up to 4th week after that there was no significant improvement in each groups. significant CMT reduction was visible in each group in the follow up period(p=0.001). Among the groups CMT reduction was significantly better in combine (IVB+IVT) group till 6 weeks of follow up(second week: p<0.001, 4th week: p=0.041, 6th week: p=0.51) but CMT changes were not significant among the groups at 12th week and 24th week after injection. Overall, retreatment was applied for 66 eyes up to 24 weeks (33 in the IVB group, 30 in the IVB+IVT group). Despite in 3 eyes within IVB+IVT groups IOP was raised beyond 21mmhg, all of them were controlled with topical anti-glaucoma medications within 1 week. Changes in lens opacity were not significant among groups.

IVB plus 1mg IVT injections accompany more reduction in CMT in early post injection but this effect is transient. One mg of intravitreal triamcinolone in combination with Bevacizumab was not accompanied with significant side effects and seems to be safer than higher dosages that use more prevalent.