Comparison of Efficacy of Suprachoroidal Triamcinolone Acetonide Alone or in Combination With Intravitreal Bevacizumab for Treatment of Diabetic Macular Edema: A Prospective Comparative Study

ABSTRACT Background and Aims This study was designed to evaluate the safety, efficacy, and durability of suprachoroidal triamcinolone acetonide, administered either alone or in combination with intravitreal bevacizumab (IVB), in the treatment of diabetic macular edema (DME). Methods This prospective comparative interventional study was conducted in the Ophthalmology Department at Mayo Hospital, Lahore, from May 2020 to March 2021. Sixty patients with DME were enrolled after obtaining informed consent. Baseline assessments included best‐corrected visual acuity (BCVA), intraocular pressure (IOP), a detailed fundus examination, and spectral‐domain optical coherence tomography (SD‐OCT) for measurement of central subfield thickness (CST). Participants were allocated into two groups. One group received a combination of 4 mg suprachoroidal triamcinolone acetonide and intravitreal bevacizumab, while the second group received 4 mg suprachoroidal triamcinolone acetonide alone. Patients were followed clinically and anatomically to assess treatment outcomes. Results Both groups demonstrated statistically significant reductions in CST from baseline ( p < 0.05). However, patients receiving combination therapy showed a greater reduction in CST and superior improvement in visual acuity compared to those receiving triamcinolone alone. At 3 months, CST and IOP decreased in both groups, with greater reductions in the combination group. The between‐group differences were significant for both CST ( p < 0.001) and IOP ( p = 0.032). No major safety concerns or treatment‐related complications were observed during the study period. Conclusion Suprachoroidal administration of 4 mg triamcinolone acetonide combined with intravitreal bevacizumab is more effective than triamcinolone monotherapy in reducing central subfield thickness and improving visual acuity in patients with DME. The combination approach provides superior anatomical and functional outcomes, suggesting a synergistic therapeutic effect and representing a promising treatment strategy for DME.