Topical betamethasone sodium phosphate, tetracycline hydrochloride and nonsteroidal anti‐inflammatory drugs in the treatment of diabetic macular edema: a case report

Abstract

PurposeTo report a case of clinically significant diabetic macula edema (DME) cured only with topical Betamethasone Sodium Phosphate, Tetracycline Hydrochloride and nonsteroidal anti‐inflammatory drugs.MethodsA 44‐year‐old type I diabetic woman was referred to our Unit after a partial tarsorrhaphy procedure for exposure keratopathy in her left eye. OCT examination of her right eye revealed a clinically significant DME with important visual loss (Central Macular Thickness [CMT] 716 μm, Best Correct Visual Acuity [BCVA] 20/100 Snellen). The patient refused the suggested intravitreal therapy (Ranibizumab injections with PRN protocol). Topical treatment with Betamethasone Sodium Phosphate, Naphazoline Nitrate, Tetracycline Hydrochloride (Alfaflor®, Alfa Intest, Italy) and Diclofenac (Voltaren Oftabak®, Thea, France) eye‐drops 4 times/day was started.ResultsIn the following 10 months, right CMT decreased to 335 μm and right BCVA increased to 20/25 Snellen. However, OCT scans still showed some intraretinal cysts. Topical Diclofenac was then replaced with Bromfenac (Yellox®, Bausch & Lomb, Italy) eye‐drops 2 times/day. After 4 months’ treatment, right BCVA was 20/20 Snellen and OCT scans showed a normal CMT. This treatment was continued and there was no recurrence of DME in the next 11 months of follow‐up. No adverse events were noted.ConclusionsTopical Betamethasone Sodium Phosphate and Tetracycline Hydrochloride, together with nonsteroidal anti‐inflammatory eye‐drops, might be an effective alternative for the treatment of newly diagnosed DME in patients not suitable for intravitreal therapy. Future case‐control studies are necessary to confirm these results.