| Objective:Diabetic retinopathy is a common form of diabetic ocular microvascular complications, diabetic macular edema is diabetic retinopathy, one of the most common form of diabetic retinopathy in diabetic macular edema in patients with vision can be seriously damaged. This is divided into focal macular edema, edema and diffuse edema. The former is due to the formation of micro-aneurysms occurred due to leakage and capillary segmental expansion. Photocoagulation for the treatment of these lesions are more sensitive to good effect; the latter causes not yet clear, generally considered to be due to the blood - retinal barrier dysfunction, to form a kind of hard exudate, and subsequent cystoid changes. As people of diabetic macular edema awareness of the dangers of its continued exploration of the treatment carried out, the current treatment methods are mainly laser photocoagulation, intravitreal injection, and vitreous surgery. For the retinal thickness more than 450μm in patients with macular grid laser photocoagulation is not only ineffective samples, and even the original cause of diabetic macular edema worsened vitrectomy combined with internal limiting membrane tear addition to surgery can make some of macular edema decreased, visual acuity was improved However, the duration of macular edema, hard exudate, as well as the extent of non-perfusion area if the postoperative outcome of patients after the impact, and its expensive, more complications and long-term effect is not obvious. Therefore, to explore a new method of treatment of DME has been an ophthalmologist at home and abroad continue to explore and research an important issue. In recent years, intravitreal injection into a hot topic in triamcinolone acetonide is a long-acting synthetic glucocorticoid, a powerful anti-inflammatory anti-proliferative effect, in recent years found, TA significantly reduce the DME, to improve the central vision in patients with . Bevacizumab is a full-length recombinant human monoclonal antibody against vascular endothelial growth factor directly to all subtypes of the biological activity, as early as 2005 for the treatment of intravitreal injection of choroidal neovascularization, and achieved encouraging results, In recent years, increasingly used in treatment of macular edema, and achieved certain results. This study compared a simple intravitreal injection of triamcinolone acetonide and anti-Vascular Endothelial Growth Factor Monoclonal Antibody Bevacizumab treatment of diabetic macular edema, before and after treatment by observing the visual acuity, intraocular pressure, central macular thickness,,macular Area leakage area changes and the presence or absence of side-effects to a comprehensive evaluation of its efficacy and safety in order to find a diabetic macular edema for the effective and safe method of treatment.Methods:1 Choose the proliferation of pre-or proliferative phase of DRⅣpatients by fundus examination, fundus fluorescein angiography and optical coherence tomography scan diagnosed as diffuse diabetic macular edema, and central visual acuity less than 0.4 of the 60 patients included 55 cases observed.2 Treatment: Patients were randomly divided into two groups intravitreal injection of triamcinolone acetonide (TA) (4mg, 0.1ml) or Bevacizumab (1.25mg, 0.05ml) treatment. TA group of 27 patients with 30, Bevacizumab group of 28 patients with 30, the two groups in preoperative age, duration, visual acuity, intraocular pressure, central macular thickness has had no significant difference.3 Follow-up: Comparison of treatment before and after treatment 1,3,6 months between the two groups, as well as within each group vision, intraocular pressure, CMT, and the macular leakage area of change.4 Statistical analysis: Application SPSS13.0 statistical software for statistical analysis. Measurement data with the X±S said that the calculation of preoperative and postoperative visual acuity after each time, CMT, the mean and standard deviation of IOP, using paired t test to compare patients before and after treatment visual acuity, intraocular pressure changes; use into the group design t-test, comparative analysis of two groups before and after treatment CMT changes, P <0.05 as statistically significant difference in standards.Results:1 Visual: TA group compared with those before treatment after treatment and 1 month (t =- 6.238, P = 0.000), 3 months (t =- 7.664, P = 0.000) significantly increased in patients with visual acuity at 6 months, the average decline in visual acuity before treatment showed no significant difference (t =- 0.574, P = 0.093). Bevacizumab group 1 month (t =- 7.004, P = 0.000), 3 months, visual acuity significantly increased (t =- 4.339, P = 0.000), 3 months, visual acuity over 1 month has dropped slightly, but still The difference before treatment (t =- 2.776, P = 0.015), 6 months, visual acuity and stability, with no significant difference between pre-treatment (t =- 0.439, P = 0.077). Between the two groups after treatment, 3 months a significant difference (t = 0.032, P = 0.047), TA group was better than Bevacizumab group. After treatment 1 (t =- 0.098, P = 0.767), 6 (t = 1.430, P = 0.201) months, no significant difference.2 CMT: TA group 1 month after treatment central macular thickness compared with the pre-treatment significantly decreased (t = 18.32, P = 0.000), and 3 months after treatment 1 month after treatment compared to significantly lower (t = 10.85, P = 0.039), after treatment for 6 months and 3 months after treatment was significantly higher compared to (t = 19.33, P = 0.000), but in comparison with those before treatment, were still significantly lower (t = 11.32, P = 0.013). Bevacizumab group 1 month after treatment foveal thickness decreased compared with before treatment (t = 16.12, P = 0.000), treatment of macular edema 3 months after further absorption, as compared with those before treatment, the difference was significant (t = 17.65, P = 0.000), after treatment for 6 months and 3 months after treatment compared with foveal thickness increased, and 3 months after treatment a significant difference (t = 18.22, P = 0.000), but pre-treatment compared with no significant difference (t = 3.01, P = 0.076). Ratio between the two groups after the treatment 1 (t = 1.804, P = 0.075), 3 (t = 0.553, P = 0.583) months, no significant difference. After treatment 6 (t = 2.732, P = 0.041) months, there are significant differences, TA group to reduce the degree CMT group than Bevacizumab.3 FFA: TA group after treatment 1,3 months follow-FFA showed macular leakage area at the same time (7 minutes) compared with pre-treatment in varying degrees of reduced 6 months 70% of patients had an area of macular leakage increased, as compared with the pre-treatment to reduce apparent, indicating edema another relapse. Bevacizumab group 1 month after treatment at the same time when the macular area of both to reduce leakage, 3 months with 67.7% of patients reviewed macular leakage area increased again, 6 months, 83.3% of patients reviewed had macular District leakage area increased again, indicating edema recurrence, but lower than before treatment were compared to alleviate.4 IOP: TA group 1 month after treatment than before treatment increased (t = 4.58, P = 0.003), treatment 3 months after (t = 1.36, P = 0.223), 6 months, compared with those before treatment was no significant difference (t = 0.86, P = 0.412). Bevacizumab group before and after treatment no significant difference in IOP. TA group 1,3,6 months after treatment were 20%, 13.3%, 6.7% elevation of intraocular pressure.Conclusion:1 Bevacizumab intravitreal injection or TA, of treatment of DME can significantly improve vision, reduce macular edema, but a period of time after treatment of recurrence of edema and varying degrees, visual acuity decreased again.2 Intravitreal injection of TA treatment of DME, to improve visual acuity can be maintained about half a year, 3 months after treatment to achieve the best effect.3 Intravitreal injection of Bevacizumab is also effective in reducing diabetic macular edema, postoperative visual acuity was improved stability, and 1 month after treatment to achieve the best effect. 4 Treatment of intravitreal injection of Bevacizumab intravitreal injection of TA compared with DME to maintain a short time, the role of weak effect of vitreous cavity injection of TA is more prominent5 Glass body cavity injection of TA is mainly complications of intraocular pressure, mostly occurring in the month after injection, multi-lowering intraocular pressure that can be topical medications, vitreous cavity injection of Bevacizumab found no elevation of intraocular pressure and other symptoms, the application is more secure .6 Bevacizumab intravitreal injection of TA, or treatment of DME can only improve in the short term vision, not improve the long-term prognosis of visual acuity is required multiple injections.
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