Abstract
Purpose: To compare the effectiveness of intravitreal bevacizumab (IVB) combined with macular photocoagulation (MPC) for the treatment of patients with different optical coherence tomography (OCT) patterns of diabetic macular edema. Methods: In this prospective study were included 72 eyes of 58 patients with nonproliferative diabetic retinopathy (NPDR) and nontractional DME with central macular thickness (CMT) over 300 μm. The eyes were categorized into three groups according to OCT features: 22 eyes with diffuse retinal thickening (DRT), 30 eyes with cystoid macular edema (CME), 20 eyes with serous retinal detachment (SRD). All patients received a single dose (1.25mg/0.05ml) of IVB. MPC was applied one month later (25-30 days). Early Treatment Diabetic Retinopahty Study ( ETDRS) best corrected visual acuity (BCVA) and СМТ were assessed before and after the treatment (in the 1st, 3rd and 6th month). Results: At month 6, mean BCVA changed with +8.27 ± 10.7 ETDRS letters (P=0.074), -0.97 ± 8.2 ETDRS letters (P=0.351) and +1.8 ± 10.1 ETDRS letters (P=0.925), respectively, for DRT, CME and SRD groups. Mean CMT decreased by 80.7 ± 65.7 μm (P=0.003) in DRT group, by 24.5 ± 104.6 μm (P=0.909) in CME group and by 51.7 ± 124.3 μm (P=0.580) in SRD group. The DRT group was associated with superior BCVA improvement and greater reduction in CMT as compared with the CME and SRD groups. Conclusions: Intravitreal injection of bevacizumab combined with MPC is more effective in the DRT pattern than in the CME or SRD patterns of DME. The pattern of DME shown by OCT may predict the effectiveness of combination treatment.
Highlights
Diabetic macular edema (DME) is the leading cause of vision impairment in the diabetic population which leads to visual disability when therapy is delayed or applied improperly
Many authors [6,7,8,9,10] found that intravitreal injection of triamcinolone has a shortterm positive effect on diffuse and persisting DME after laser therapy, but its application leads to local complications like raised intraocular pressure and development of cataract [6,10]
The purpose of the present study is to compare the effectiveness of intravitreal bevacizumab (IVB) combined with macular photocoagulation (MPC) for the treatment of patients with different optical coherence tomography (OCT) patterns of diabetic macular edema
Summary
Diabetic macular edema (DME) is the leading cause of vision impairment in the diabetic population which leads to visual disability when therapy is delayed or applied improperly. There were only three methods to reduce the risk of DME-induced vision loss: laser photocoagulation (LPC) [1], intensive glycemic control [2] and blood pressure control [3]. As a large portion of patients with DME treated with LPC did not show improvement of visual acuity [1,4,5], other methods of treatment began to be applied, including pharmacological agents , surgery, combined therapy, genetic therapy. Many authors [6,7,8,9,10] found that intravitreal injection of triamcinolone has a shortterm positive effect on diffuse and persisting DME after laser therapy, but its application leads to local complications like raised intraocular pressure and development of cataract [6,10].
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