Intravitreal Triamcinolone Acetonide Versus Intravitreal Bevacizumab for Refractory Diabetic Macular Edema (IBEME Study)

Inclusion Criteria: * Refractory diffuse DME (defined herein as clinically significant DME \[by biomicroscopic evaluation\] unresponsive to focal laser photocoagulation \[performed at least 3 months before evaluation\] and generalized breakdown of the inner blood-retina barrier with diffuse fluorescein leakage involving the foveal center and most of the macular area on fluorescein angiography), * Snellen logarithm of minimum angle of resolution (LogMAR) BCVA equivalent of 20/40 or worse, and 3) central macular thickness (CMT) greater than 300µm on optical coherence tomography (OCT) Exclusion Criteria: * Aphakic or pseudophakic eyes, * Glycosylated hemoglobin (Hb A1C) rate above 10%, * History of glaucoma or ocular hypertension, * Loss of vision as a result of other causes, * Systemic corticoid therapy,. * History of thromboembolic event (including myocardial infarction or cerebral vascular accident); * Major surgery within the prior 6 months or planned within the next 28 days; * Uncontrolled hypertension (according to guidelines of the seventh report of the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure \[JNC-7\]);16 * Known coagulation abnormalities or current use of anticoagulative medication other than aspirin; * Severe systemic disease; or * Any condition affecting follow-up or documentation