Intravitreal bevacizumab injection versus intravitreal bevacizumab injection followed by macular grid laser photocoagulation for diabetic macular edema

Abstract

Background: Diabetic macular edema is the commonest cause of visual impairment in diabetic patients. The aim of the study is to evaluate the effectiveness of repeated intravitreal bevacizumab injections alone versus injection with sequential macular grid laser photocoagulation in patients with diabetic macular edema. Methods: This study included 128 eyes of 64 patients with bilateral diabetic macular edema, randomly assigned into two groups. First group was treated with monthly intravitreal bevacizumab injections (IVB group). Second group was treated with 3 monthly IVB injections, followed by macular grid photocoagulation (MGP) 4 weeks later (combined group). All patients received a complete ophthalmic examination including measurement of best corrected visual acuity (BCVA) and measurement of central macular thickness (CMT) by optical coherence tomography at baseline and 3 weeks after each injection. Results: At the end of the follow-up period there was a statistically significant difference between the mean BCVA and the CMT compared to baseline in both groups. In the IVB group at the end of study, the mean BCVA was 0.46±0.11 LogMAR compared to 0.79±0.16 LogMAR preoperatively, and the mean CMT was 248.49±13.40µm compared to 497.25±27.97µm preoperatively. In the combined group the mean BCVA was 0.41±0.12 LogMAR compared to 0.89±0.12 LogMAR preoperatively, and the mean CMT was 239.47±13.53µm compared to 510.86±37.64µm preoperatively. The mean number of injections was significantly lower in combined group. Conclusion: Intravitreal injection of bevacizumab is effective in controlling DME. Performing MGP 4 weeks after the third injection decreased the number of IVB injections needed during the study duration.