مقارنة بين مضاد عامل نمو بطانة الأوعية الدموية (بيفاسيزوماب) والكورتيكوستيرويد (تريامسينولون أسيتونيد) في علاج الوذمة البقعية السكرية المقاومة للعلاج

Objective: To compare the effectiveness and ocular safety of intravitreal bevacizumab and triamcinolone acetonide in refractory diabetic macular edema. Methods: This retrospective comparative study at Tripoli Eye Hospital, Libya, included 50 patients with an insufficient response to three previous bevacizumab injections. Twenty-five received three monthly bevacizumab injections (1.25 mg/0.05 mL), and 25 received one triamcinolone injection (4 mg/0.1 mL). Central macular thickness (CMT), best-corrected visual acuity (BCVA), and ocular complications were assessed over six months. Results: At three months, mean CMT decreased from 418 to 315 µm with bevacizumab and from 420 to 255 µm with triamcinolone; mean BCVA increased from 0.15 to 0.25 and 0.50, respectively. Between-group differences favored triamcinolone at one and three months. At six months, CMT was 285 versus 275 µm (p = 0.47), and BCVA was 0.40 in both groups (p = 1.00). Intraocular pressure elevation and cataract occurred in 32% and 24% with triamcinolone versus 8% and 4% with bevacizumab. Conclusion: Triamcinolone provided greater early improvement, but no significant between-group differences remained at six months. Its higher frequency of ocular complications warrants careful monitoring.