Observation on the clinical efficacy of combined therapy for the treatment of diabetic macular edema

Abstract

Objective To observe the clinical efficacy of intravitreal Ranibizumab combined with macular grid photocoagulation for treatment of diabetic macular edema (DME). Methods Sixty eyes of 60 patients with DME in the First Affiliated Hospital of Zhengzhou University from November 2013 to October 2014.They were randomly divided into 2 groups: the combined therapy group of 30 eyes and the control group of 30 eyes.The patients in combined therapy group received intravitreal Ranibizumab injection, and then combined with standard macular grid photocoagulation one week later. The patients in the control group received intravitreal Ranibizumab only.The visual acuity was examined with standard chart.The vision results converted into logarithmic of the minimum angle resolution (logMAR) to record. The changes of the logMAR of best corrected visual acuity (BCVA) and central macular thickness (CMT) before and 1, 3, 6 months after the treatment were compared. The average BCVA of the combined therapy group before treatment was 0.75±0.32 and the average BCVA of control group was 0.74±0.29.There was no statistically significant difference (t=0.20, P=0.83) in BCVA between the two groups. The average CMT is (486.87±92.44)μm in the combined therapy group and(487.13±86.519)μm in the control group before treatment.There was no statistically significant difference (t=1.247, P=0.089) in the CMT of two groups. Results At 1, 3, 6 months after the treatment, the BCVA of patients in control group were(0.41±4.10), (0.40±0.85)and(0.36±9.85)and the CMT were (273.53±103.36)μm, (275.21±92.14)μm and (274.65±93.21)μm, respectively. Howerer, in combined therapy group, the BCVA were (0.44±1.60), (0.43±1.73)and(0.44±2.36)and the CMT were (273.53±103.36)μm, (275.21±92.14)μm and (274.65±93.21)μm respectively. There were statistically significant differences (t=2.16, P=0.04; t=2.34, P=0.02; t=4.25, P=0.00)in the BCVA and in the CMT (t=2.114, P=0.021; t=2.352, P=0.015; t=2.534, P=0.008)at 1, 3, 6 months after the treatment between the two groups.The BCVA in both two groups were significantly improved compared with that of preoperative (P<0.05). The CMT decreased rapidly after the treatment(P<0.05). During the follow-up, the BCVA presented declining trend and the CMT was on the rise slowly in the control group. The BCVA and CMT in combined therapy group remained stable. Conclusion Intravitreal Ranibizumab injection combined with macular grid photocoagulation and simple Ranibizumab intravitreal injection can improve the vision and reduce macular edema in DME patients and the therapeutic efficacy of the combined group is more stable than the control group. Key words: Macular edema, diabetic; Ranibizumab, intravitreal injection; Grid photocoagulation, macular