Visual outcomes following intravitreal bevacizumab and focal laser in diabetic macular edema

Dr Nupur Sharma,Dr Priti Singh,Dr Neha Singh,Dr Kavita Kumar

doi:10.17511/jooo.2019.i06.07

Dr Nupur Sharma, Dr Priti Singh + Show 2 more

Open Access

https://doi.org/10.17511/jooo.2019.i06.07

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Abstract

Purpose: The aim of this study was to evaluate the visual outcome and central macular thickness (CMT) after intravitreal injection of bevacizumab followed by focal laser for the treatment of Diabetic Macular Edema (DME). Patients and methods: This is a prospective, observational study. A total of 30 eyes of 30 patients with Diabetic macular edema were included in this study. The following data were recorded at baseline and during the follow-up periods (≤6 months): best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, CMT and intraocular pressure measurement by applanation tonometry. All eyes received intravitreal bevacizumab at a dose of 1.25 mg in 0.05 ml followed by focal laser after 2 weeks. Results: This study included 30 eyes of 30 patients, the mean age of the patient 59.4±8.5 years. There were 19 males and 11 females. The mean baseline BCVA in LogMAR was 0.78±0.23, and the final mean BCVA at 6 months had improved to 0.45±0.20. Significant improvement was seen in all the patients over the study period (p<0.001). Mean CMT at baseline was 485±122 μm, which decreased to a mean of 321±82μm at the end of the follow-up period (6 months). Conclusion: Primary treatment for DME with intravitreal bevacizumab followed by focal laser results in improvement of vision and reduces CMT. Combined therapy seems to be an effective modality for treatment of DME.

Highlights

Diabetes mellitus (DM) is a chronic disease affecting the end-organs, including the retina
The diagnosis of Diabetic Macular Edema (DME) is based on binocular slit-lamp biomicroscopy (SLB), the Manuscript received: 10th October 2019 Reviewed: 20th October 2019 Author Corrected: 27th October 2019 Accepted for Publication: 31st October 2019 qualitative and quantitative information of retinal structure and thickness offered by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA)
In focal laser spots are applied over leaking microaneurysm which stops the leakage and reduces macular edema and in grid laser spots are applied over RPE over the areas of diffuse leakage, which increases the reuptake of edema by the RPE pump [11]

Summary

Introduction

Diabetes mellitus (DM) is a chronic disease affecting the end-organs, including the retina. The sightthreatening complications of Diabetic Retinopathy (DR) are Diabetic Macular Edema (DME), Retinal detachment, Proliferative diabetic retinopathy (PDR), Retinal artery/vein occlusions. DME is clinically significant when it fulfils following criteria: 1) Retinal edema located at or within 500 microns of the center of the macula. 2) Hard exudates at or within 500 microns of the center, if associated with thickening of adjacent retina. 3) A zone of thickening larger than 1disc area, if located within 1-disc diameter of the center of the macula. The classification of DME, as described by Otani et al [3]:1) Spongy-like retinal swelling (SE) 2) Cystoid macular edema (CME) 3) Foveal Serous retinal detachment (FSRD)

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