14.
Pro Triamcinolone, contra Anti-VEGF
Hans Hoerauf (Göttingen)
Intravitreal steroids and anti-VEGF-substances are injected regularly, can reduce the edema
and may - if photoreceptor recovery occurs – enhance visual acuity, however, cannot cure diabetic
edema so far. In this talk the advantages of intravitreal triamcinolone acetonide (IVTA)
and the disadvantages of anti-VEGF-treatment, both currently used “off label”, will be presented.
There are several observations in favour of IVTA:
1) its longer lasting effect and reduced reinjection rate
2) an inhibitory effect of TA on osmotic glial swelling
3) a stronger effect of TA on edema resorption in contrast to bevacizumab
4) the pathogenosis of DME may not only be attributable to VEGF-dependency but also to
other mechanisms suppressed by corticosteroids
Con-arguments against Anti-VEGF therapy:
1) VEGF acts as a key regulator of angiogenesis
2) VEGF blocking may increase macular ischemia
3) systemic side effects of repeated anti-VEGF reinjections in diabetic individuals are unclear.