Diffuse Diabetic Macular Edema Research Articles

The Association of Systemic Endothelial Dysfunction With Diffuse Diabetic Macular Edema.

Our aim was to assess whether systemic endothelial dysfunction, evaluated non-invasively by flow mediated dilation (FMD), is associated with diabetic macular edema (DME) and to determine if it is further impaired in patients with diffuse-DME. Consecutive patients (n = 84) with type-2 diabetes mellitus (T2DM) and diabetic retinopathy were enrolled. DME was not present in 38 (non-DME) and present in 46 patients; 25 with focal and 21 with diffuse-DME. No differences were detected between DME and non-DME groups regarding the clinical and demographic characteristics, except for the age of T2DM initiation (lower in non-DME). FMD values were significantly impaired in DME compared with non-DME patients, even after adjustment for multiple covariates (3.56 ± 1.03 vs 4.57 ± 1.25%, P = .003). Among DME patients, no differences were found concerning the clinical and demographic data, while FMD levels were significantly lower in diffuse-DME patients, compared with the focal-DME ones, regardless of the impact several confounders (2.88 ± 0.65 vs 4.08 ± 0.95%, P = .002). It is noteworthy that FMD values of non-DME and focal-DME patients did not differ significantly (4.52 ± 1.24 vs 4.21 ± 1.06%, P = .307). Moreover, among DME patients, impaired FMD was an independent predictor of diffuse-DME (odds ratio: 0.06, 95% CI 0.01-0.47, P = .007).

Intravitreal Lucentis (Ranibizumab) as A Treatment for Diffuse Diabetic Macular Edema

Introduction: Humanized anti-VEGF (Vascular endothelial growth factor) antibody fragment Lucentis (Ranibizumab) is prescribed to treat neovascular (wet) age-related macular degeneration, diabetic macular edema, diabetic retinopathy, and myopic choroidal neovascularization. It is also used to treat macular edema following retinal vein occlusion. Objective: This study was carried out to evaluate the anatomic effect and visual acuity response following intravitreal Lucentis (Ranibizumab). Methodology: In this investigation, diffuse diabetic macular edema was present in 30 eyes belonging to 30 patients with stable diabetes mellitus. Every eye had undergone argon laser photocoagulation, either Focal, Grid, or pan-retinal photocoagulation (PRP), for a minimum of three months. The patients with a mean age was 58.13±5.17 years were treated with two intravitreal injections of 0.5 mg of ranibizumab in 0.05 ml spaced four weeks apart. A skilled ophthalmologist assessed each patient's best-corrected visual acuity (BCVA), also assessed their central macular thickness (CMT) using optical coherence tomography, and assessed their diabetic retinopathy at both the baseline and follow-up sessions. The results: The results showed that the means of BCVA were significantly (P<0.01) decreased from baseline (1.189±0.077 logMAR) to 1 month (0.162±0.058 logMAR) and 3 months (1.109±0.049 logMAR) after injection. Also the results revealed that the mean of CMT were significantly (P<0.01) declined from the baseline (477.47±151.32 µm) to 1 month (438.27±115.68 µm) and 3 month (396.80±115.26 µm) after treatment. Conclusions: The study concluded that after three months of the second injection of Lucentis (ranibizumab) significantly reduced central macular thickness and improved visual acuity, then diffuse diabetic macular edema is significantly improved and treated using Lucentis (ranibizumab).

Анализ эффективности анти-VEGF терапии диабетического макулярного отека в авитреальных глазах

Aim. To analyze the clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in avitreal eyes. Methods. 34 patients (38 eyes) with vitreous loss and DME on the background of preproliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) were examined in the main study group. The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injections of Lucentis 0.5 mg (IVIL) were carried out according to «three monthly injections» scheme, then – to «on demand» scheme. Results. Complete regression of DME in avitreal eyes occurred in 74 % of cases; in eyes with native vitreous body – in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed that number of IVIL was significantly less in patients with DME on the background of PPDR than PDR. Conclusion. Presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in DME treatment is comparable in eyes with native vitreous body and avitreal eyes. Key words: diabetes mellitus; diabetic macular edema; preproliferative diabetic retinopathy; proliferative diabetic retinopathy; avitria; Lucentis intravitreal injections.

Клиническая эффективность лечения диабетического макулярного отека в авитричных глазах путем применения анти-VEGF терапии

Purpose. To analyze clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in eyes with vitreous loss. Material and methods. 34 patients (38 eyes) with vitreous loss and DME were examined: on the background of pre-proliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) (the main group). The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injection of Lucentis 0.5 mg (IVIL) was carried out according to scheme «three monthly injections», then — to scheme «on demand». Results. Complete regression of DME in eyes with vitreous loss occurred in 74 % of cases; in eyes with native vitreous body — in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed, that number of IVIL was significantly less in patients with DME on the background of PPDR, than with PDR. Conclusions. The presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in treatment of DME is comparable in eyes with native vitreous body and vitreous loss. Keywords: diabetes mellitus, diabetic macular edema, pre-proliferative diabetic retinopathy, proliferative diabetic retinopathy, vitreous loss, Lucentis intravitreal injection

LUCENTIS IN THE TREATMENT OF DIABETIC MACULAR EDEMA, TWO-YEAR RESULTS.

To evaluate, on the basis of two-year observations, the effectiveness of intravitreal treatment with Ranibizumab in patients with diabetic macular edema (DME) unresponsive to the previous laser treatment. Cohort and Methods: A retrospective study evaluates 29 eyes of 29 patients with diffuse DME unresponsive to their previous laser treatment. The group of the patients consisted of 16 males (55.1%) and 13 females (44.8%); their mean age was 71.3. The mean duration of diabetes mellitus was 13 years (3-20). 19 patients (65.5%) were treated with insulin, 10 patients (34.4%) were treated with peroral antidiabetics (PAD); the mean HbA1c value was 52 mmol/l. The treatment was started with 3 initial doses of intravitreal injections of Ranibizumab 0.5 mg. There was a one- -month interval between the applications. Subsequent evaluations and administrations of the following injections were made in the pro re nata (PRN) mode; the check-ups were carried out every month during the first year and on average every 3 months in the second year. The monitored parameters: the best corrected visual acuity (BCVA) measured on ETRDS (Early Treatment Diabetic Retinopathy Study) optotypes, the central retinal thickness (CRT). These parameters were monitored prior to the treatment and then in the 3rd, 6th, 9th, 12th, 18th and 24th months. A statistically significant improvement in the mean value of BCVA was detected. From the initial 65.4 ±10.61 letters it improved by 11.2 letters (p.

IS A DECREASED NITRIC OXIDE CONCENTRATION AFTER TRIAMCINOLONE ACETONIDE INTRAVITREAL INJECTION ONE OF THE REASONS FOR INTRAOCULAR PRESSURE RISE?

Diabetic macular edema is the most common cause of vision loss in patients affected by diabetes mellitus. For eyes with persistent retinal thickening despite anti-VEGF therapy, treatment with intravitreal triamcinolone may be considered, especially in pseudophakic eyes. The aim of this study was to examine aqueous humor nitric oxide concentration changes in pseudophakic eyes with persistent diffuse diabetic macular edema after intravitreal injection of triamcinolone acetonide, as well as the potential impact of these changes on the intraocular pressure values. In 10 pseudophakic eyes with persistent diffuse diabetic macular edema, paracentesis of anterior chamber with aspiration of aqueous humor and nitric oxide concentration measurements were done on the day of the intravitreal application of 20 mg triamcinolone acetonide, and after 1, 3, 6 and 9 months. Also, we were recording intraocular pressure values before the intravitreal triamcinolone acetonide injection and during the next 9 months. One month after the intravitreal triamcinolone acetonide injection, we noticed a decrease of nitric oxide concentration (45.37±5.55 µmol/L) by 31.79% compared to the initial values (66.52±7.66 µmol/L). After that, nitric oxide concentrations began to rise slightly, and at the end of the ninth month the mean nitric oxide concentration was similar to that recorded at the beginning of the study. Intraocular pressure values had increasing trend one month after the intravitreal triamcinolone acetonide injection (23.70±4.08 mm Hg) compared to the initial values (16.21±1.55 mm Hg), but after nine months these values returned to normal levels. Decreased concentration of nitric oxide could be one of the reasons for increased intraocular pressure after intravitreal application of triamcinolone acetonide in the treatment of diffuse diabetic macular edema.

Features of pathological changes in the retina and vitreoretinal interface in the macular zone in patients with diabetic macular edema

Background. Diabetic macular edema (DME) is one of the main causes of decreased central vision. Determining the reasons for the refractoriness of DME to treatment is an urgent problem.Aims. Based on the analysis of optical coherence tomography, to study the features of pathological changes in the retina and vitreoretinal interface (VRI) in the macular zone in patients with DME.Materials and methods. We studied 587 patients (587 eyes) with diffuse DME in the setting of nonproliferative diabetic retinopathy. In addition to the standard ophthalmological examination, everyone underwent optical coherence tomography of the macular zone with an assessment of structural changes in the retina, morphometric parameters, and the state of the VRI.Results. In 351 patients (59.80 %) with DME, pathological variants of the VRI were revealed, in which the best corrected visual acuity was significantly lower, and the morphometric parameters (retinal thickness and macular volume) were signifi cantly higher. Analysis of morphostructural changes in the macular zone revealed that in pathological VRI, neuroepithelial detachment and high edema are more common, and cystic edema is larger in area compared to the group with a normal VRI. With detachment of neuroepithelium against the background of a pathological VRI, the worst morphometric data are determined, with solid exudates in the macula, the worst indices of visual loss are determined.Conclusions. The pathological VRI in patients with diabetic macular edema occurs in more than half of the cases and is characterized by a high incidence of neuroepithelial detachment, high edema, higher morphometric parameters with worse visual acuity. At the same time, the presence of neuroepithelial detachment corresponds to the worst morphometric indicators of the macular zone, and the presence of solid exudates corresponds to a lower maximum corrected visual acuity. Further research is needed to assess the effect of the listed morphostructural and morphometric changes in combination with various pathological variants of VRI on the effectiveness of DME treatment.

Структурно-функциональные особенности центрального отдела сетчатки и совершенствование хирургического лечения больных с диабетическим макулярным отеком и эпиретинальной мембраной

Purpose. Improving the efficiency of surgical treatment of patients with diabetic macular edema and epiretinal membrane. Material and methods. Clinical studies were based on the analysis of morphological and functional parameters of the central retina. Patients with diffuse diabetic macular edema (DME) and epiretinal membrane (ERM) made up group A (main) of 96 people (96 eyes). Group B (control) included 22 patients (44 eyes) without ophthalmological diseases. Depending on the chosen method of surgical treatment, patients in group A were divided into three subgroups. Results. According to the data of optical coherence tomography, it was revealed that the average index of retinal thickness as a result of edema increased by 1.35 times (p=0.011) compared with group B. When conducting microperimetry in the macular zone in patients of group A, the total light sensitivity was reduced in 1.88 times compared with group B (p=0.028). Comparative analysis of long-term results of surgical treatment of patients with DMO and ERM showed that complex simultaneous vitrectomy and administration of an angiogenesis inhibitor is preferable compared to delayed administration of drugs, which is confirmed by a decrease in the total thickness of the retina in 78.3% of cases, preservation of the total photosensitivity of the central part of the retina on average, up to 15.3±3.24 dB, visual acuity - up to 0.51±0.22, no recurrence of edema in 63.4% of patients and the development of ERM - in 100% of cases. Conclusion. If the central thickness of the retina at the preoperative stage is less than 400 microns, it is possible to use a step-by-step method (vitrectomy + intravitreal administration of an angiogenesis inhibitor after 1 month). The use of the proposed one-step operation technique is preferable when the retina thickness is more than 400 microns. Vitrectomy with peeling of the internal limiting membrane in patients with cysts in the retinal edema zone with a diameter of more than 200 µm does not lead to a positive anatomical and functional result. Key words: diabetic macular edema, angiogenesis inhibitor, vitrectomy, microperimetry, epiretinal membrane.

Surgical effects of internal limiting membrane peeling with vitrectomy for vitreo-macular traction in diabetic patients

Aim: To evaluate the surgical effects of internal limiting membrane (ILM) peeling with parsplana vitrectomy in diffuse diabetic macular edema with vitreo-macular traction as regard the best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction. Methods: The study included twenty eyes of twenty patients with diffuse diabetic macular edema and vitreo-macular traction. Seven eyes underwent vitrectomy with ILM peeling (group I) and thirteen eyes underwent vitrectomy without ILM (group II). The inclusion criteria were diffuse diabetic macular edema with optical coherence tomography evidence of vitreo-macular traction with or without epiretinal membrane. Exclusion criteria involved any ocular disease can cause macular edema rather than diabetes mellitus and eyes with macular ischemia. The effect of ILM peeling was evaluated on the surgical outcomes as regard best corrected visual acuity, central foveal thickness, residual epiretinal membrane and recurrent traction at postoperative one, three and six months. Results: Statistically significant improvement of best corrected visual acuity and reduction of central foveal thickness occurred in all eyes postoperatively and over time with statistically insignificant difference between both groups. No eyes in group I and eight eyes in group II showed residual epiretinal membrane with a statistically significant difference between both groups. No eyes in group I and two eyes in group II showed recurrent traction due to residual epiretinal membrane with a statistically insignificant difference between both groups. Conclusion: ILM peeling has an important role in complete removal of epiretinal membrane and prevention of recurrent traction.

Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema: A Meta-analysis

Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema: A Meta-analysis

Dril Influences Short-term Visual Outcome after Intravitreal Corticosteroid Injection for Refractory Diabetic Macular Edema

ABSTRACT Purpose: Intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) are considered the gold standard for diabetic macular edema (DME). Despite adequate anti-VEGF treatments, many patients present persistent DME. The aim of this study is to identify systemic, ocular and anatomical characteristics influencing functional and anatomical outcomes in refractory DME patients treated with IVI of corticosteroid. Materials and Methods: Retrospective multicenter hospital-based cohort study including type 2 diabetic adult patients with refractory DME that switched from intravitreal anti-VEGF to intravitreal corticosteroid between January 2017 and September 2018. Sociodemographic, clinical data, DME and treatment characteristics were collected at baseline (visit before switch), as well as spectral domain OCT features. Results: A total of 101 eyes were included. The median number of anti-VEGF injections before switch was 5.0 (min-max: 4.0–9.0) and the median anti-VEGF treatment duration before switch was 33.2 (min-max: 19.5–50.3) months. More than half of the patients (56; 54.9%) were diagnosed with diffuse DME. At baseline, 80 (88%) patients had cystoid DME, 55 (62.5%) patients had disorganization of retinal inner layers (DRIL) and 16 (17.6%) had subretinal fluid. Dexamethasone was the corticosteroid more commonly used (71.4%), followed by triamcinolone (24.4%) and fluocinolone (4.2%). Regarding best corrected visual acuity (BCVA), post-switch results showed no statistically significant improvement at three-month follow-up (p = .048/0.096), but the mean central macular thickness (CMT) decreased significantly from 486.3 (SD = 159) µm to 369.3 (SD = 129) µm at three-month follow-up (p < .001). DRIL was the tomographic characteristic able to influence significantly both CMT and BCVA final results (p = .02 and 0.012, respectively). Conclusions: Subfoveal DRIL on structural OCT was the DME factor influencing significantly clinical and imaging outcomes in refractory DME patients treated with intravitreal corticosteroid. Portuguese care trend towards DME shows preference for the use of dexamethasone implant after therapeutic failure with ranibizumab or bevacizumab injection.

Subthreshold micropulse laser adjuvant to bevacizumab versus bevacizumab monotherapy in treating diabetic macular edema: one- year- follow-up.

Purpose:To compare the therapeutic impact of combining intravitreal injections of bevacizumab (IVB) with micropulse laser (MPL) in central diffuse diabetic macular edema (DME) versus IVB monotherapy during 12 months follow-up.Methods:We conducted a retrospective comparative study of 98 treatment-naive eyes (63 patients) with central diffuse DME. The first group of patients (IVB + MPL group, n = 49) was treated with 3 monthly IVB followed by MPL within 1 week after the third injection. Patients were then followed and treated on a pro re nata (PRN) basis, with MPL retreatment if necessary. The changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), number of IVB injections and MPL sessions were evaluated at 4, 8, and 12 months. A control group of diabetic patients with treatment-naive DME was treated with standard protocol of 3 monthly IVB as monotherapy then followed on a PRN basis (IVB group, n = 49). Statistic comparaison of BCVA, CMT, and IVB number variation was interpreted at 12 months between both groups.Results:In IVB + MPL group, baseline BCVA improvement was not significant at 4 and 8 months (p = 0.90, p = 0.08), and was statistically significant (p = 0.01) at 12 months. Mean CMT significantly decreased at 4, 8, and 12 months (p < 0.01) in IVB + MPL group. The difference in BCVA (p = 0.091) and CMT (p = 0.082) variation at 12 months between both groups was not significant but the number of injections was significantly lower in IVB + MPL group (4.1 ± 1.5 injections) compared to IVB group (7.2 ± 1.3 injections) (p < 0.005).Conclusion:Combining intravitreal injections of bevacizumab and MPL in the treatment of DME is effective and safe. This protocol may decrease the number of IVB and its frequency. It offers the advantage of lasting therapeutic response with fewer recurrences.

Alone laser versus bevacizumab plus laser for diffuse diabetic macular edema (ALBA randomized trial).

Purpose:To report the 12-month results of laser (treatment G1) versus intravitreal bevacizumab combined with laser (treatment G2) in patients with diffuse diabetic macular edema (DME).Methods:In this single-center randomized independent controlled trial, 32 patients were randomized to G1 (n = 15) or G2 (n = 17). In G1, laser was given at baseline and then pro re nata (PRN). In G2, three intravitreal bevacizumab (1.25 mg) injections were given once every 6 weeks, then laser and then PRN. Analysis was performed by treatment as administered. This study was registered in clinicaltrials.gov as NCT01572350 and EU Clinical Trial Registry as 2009-014654-15.Results:G2 was superior to G1 improving best corrected visual acuity (BCVA) with respect baseline (+8.0 vs + 3.0; p < 0.01). At month 12, a significantly greater proportion of patients had a BCVA letter score >15 and >73 in G2 (3 of 15 (20%) and 8 of 15 (53%), respectively) versus G1 (1 of 17 (6%) and 4 of 18 (23%), respectively). Health-related quality of life, assessed through National Eye Institute Visual Function Questionnaire, at 12 months was statistically indistinguishable between both groups.Conclusion:G2 provided superior visual acuity gains over G1 in patients with visual impairment due to center-involving diffuse DME, associated with significant gains in VFQ-25 scores.

Pre-therapeutic Biomarkers for Ranibizumab Therapy among Type 2 Diabetic Patients with Diabetic Macular Edema.

A differential outcome in randomized controlled trials of anti-vascular endothelial growth factor (anti-VEGF) therapy, including ranibizumab, for diabetic macular edema is a major dilemma for planning, optimizing, and managing clinical usage. The variable outcome of the therapeutics necessitates the importance of finding a predictive biomarker for anti-VEGF therapy to improve subject selection. Our study correlates the baseline pro- and anti-VEGF isoforms and its three receptors (VEGFReceptor1, VEGFReceptor2, and VEGFReceptor3) for circulatory candidate protein molecules among diabetic patients with macular edema, with the clinical outcome of ranibizumab therapy. This study included 86 individuals who were anti-VEGF naive at the time of ascertainment but have completed the standardized therapy regimen of the clinic. Plasma proteins for pro- and anti-VEGF isoforms and its three receptors were determined in replicate by an enzyme-linked immunosorbent assay. The study demonstrated that 56 (65.12%) individuals benefited from the therapy in terms of letter gain (Snellen chart). Baseline plasma soluble VEGF receptor 2 (sVEGFR-2) was significantly higher among responders (65.10 pg/mL; 95% confidence interval, 55.41 to 74.80 pg/mL) compared with nonresponders (46.38 pg/mL; 95% confidence interval, 38.69 to 54.07 pg/mL; PFDR = .03). Diffuse diabetic macular edema with proliferative diabetic retinopathy increases the risk of nonresponse to the therapy by 3.03-fold (PFDR = .04). The present study postulates that diffuse diabetic macular edema with proliferative diabetic retinopathy and baseline circulatory soluble VEGF receptor 2 may be potential candidates as therapy-stratifying markers for ranibizumab treatment among patients with diabetic macular edema.

A study on laser photocoagulation in diabetic macular edema: Assessment with optical coherence tomography

Introduction: Diabetic macular edema (DME) is the most common cause of visual loss among diabetic patients. Macular photocoagulation is the established mode of treatment for clinically significant macular edema (CSME). Objective: This study was conducted to know the response of focal and diffuse diabetic edema separately to frequency doubled Nd:YAG. Materials and Methods: A prospective study with total of 30 consecutive eyes with Clinically Significant Macular Edema (CSME) over 8 months in our institution and divided into two groups with 15 each as focal and diffuse on the basis of fundus bio-microscopy and fluorescein angiography. Baseline measurements were done by OCT. Patients with diffuse diabetic macular edema underwent modified grid laser photocoagulation with Frequency Doubled Nd: YAG. Patients of focal diabetic macular edema underwent focal photocoagulation with Frequency Doubled Nd: YAG. Patients were followed up at 4 weeks and 12 weeks with repeat measurements by OCT with Humphrey Zeiss Stratus 3.0. Data entered in excel sheet and analyzed using SPSS software. The demographical data was analyzed with descriptive and the correlations by Pearson correlation. Results: Among 15 eyes with focal macular edema mean age of patients was 59.80 ± 5.13 years whereas among diffuse macular edema, it was 67.80 ± 3.76 years. In the focal group, the mean BCVA letter score did not reveal a significant change at 4 and 12 weeks compared with the baseline (p=0.52 and p=0.74, respectively). In the diffuse group, the mean BCVA letter score showed a gradual decrease at 4 weeks and increased at 12 weeks compared with the baseline however this was not statistically significant. When central foveal thickness, perifoveal thickness, maximum retinal thickness and total macular volume were compared at baseline, 4 weeks and 12 weeks after surgery, it was found that visual outcome was better after laser photocoagulation in CSME when assessed using OCT. Conclusion: Laser photocoagulation

INFLUENCE OF MICROPULSE LASER TREATMENT OF DIABETIC MACULAR EDEMA ON THE RETINAL PHOTOSENSITIVITY

72 patients (72 eyes) were examined with flat diffuse or focal diabetic macular edema up to 500 microns high. Patients were divided into two groups. The first group included 40 patients (40 eyes) with a treatment using a Supra 532 laser (Quantel Medical, France). The second group (control group) included 32 patients (32 eyes) with a treatment using a Supra 577 laser (Quantel Medical, France). Significant decrease of macular edema and increase of focal threshold were statistically achieved in both groups. At the same time, a statistically significant difference in the treatment efficacy between the first and second groups was not detected.

Intravitreal Avastin as a Treatment of Diffuse Diabetic Macular Edema

Background: Macular edema, defined as retinal thickening within 2 disc diameters of the center of the macula, results from retinal microvascular changes that compromise the blood-retinal barrier, causing leakage of plasma constituents into the surrounding retina and, consequently, retinal edema. Focal edema is associated with hard exudate rings caused by leakage from micro aneurysms. Diffuse edema is caused by leakage from micro aneurysms, retinal capillaries, and arterioles. Avastin (Bevacizumab) is a recombinant humanized monoclonal IgG1 antibody that binds to and inhibits the biologic activity of human vascular endothelial growth factor (VEGF). It contains human framework regions and the complementaritydetermining regions of a murine antibody that binds to VEGF. Avastin produced in a Chinese Hamster Ovary mammalian cell expression system in a nutrient medium containing the antibiotic gentamicin and has a molecular weight of approximately 149 kilo Daltons. Purpose: To assess the anatomic effect and visual acuity response after intravitreal (Avastin) in patients with diffuse diabetic macular edema. Patients and Methods: This study included 15 eyes of15 Patients with stable diabetes mellitus with diffuse diabetic macular edema. All eyes had received some form of argon laser photocoagulation (pan retinal photocoagulation (PRP), Focal or Grid of duration not less than 6 months. Mean age of 59 years treated with two intravitreal injections of Avastin 1.25 mg in 0.05 ml six weeks apart. Patients were examined by experienced ophthalmologist visual acuity, evaluation of diabetic retinopathy, central macular thickness by optical coherence tomography each was evaluated at the begging of study (baseline) and follow-up visits. Results: 15 eyes of 15 diabetic patients with persistent diffuse macular edema with no improvement in visual acuity. All the patients received two injections of A vastin six weeks apart. No complications were observed in any patient. The mean baseline visual acuity was (log Mar=1.338±0.455) and the mean visual acuity at three months following the second intravitreal injection was (log Mar=1.094±0.254), the mean central macular thickness at baseline was 492 µm decreased to 369 µm at the end of three months. Conclusions: A vastin resulted in a significant decrease in macular thickness and improvement in visual acuity at three months after the second injection.

Intravitreal Bevacizumab Alone Versus Combined Bevacizumab and Macular Grid Laser Photocoagulation in Diffuse Diabetic Macular Oedema

Introduction: Diabetes Mellitus (DM) is a common disease with multiple systemic complications. Diabetic macular oedema is the main threat to vision in patients with diabetic retinopathy, which results from the increased permeability of the inner and outer blood-retinal barrier. Macular argon laser photocoagulation was the only treatment of diabetic macular oedema in the past. Now-a-days, both intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and macular grid laser photocoagulation are used in the management of diffuse and focal Diabetic Macular Oedema (DME). Aim: To assess the changes in both visual acuity and Central Macular Thickness (CMT) in patients with DME after intravitreal injection of bevacizumab only or in combination with macular grid laser treatment. Materials and Methods: A prospective longitudinal cohort study included 89 eyes of 52 patients with DME, who were categorised into two interventional groups. The first group received only intravitreal bevacizumab for the first three months, then Pro Re Nata (PRN), while the second group received intravitreal bevacizumab, similar to the first group, in addition to macular grid laser treatment two weeks after the initial injection. Participants were followed-up at 12 months, and the visual acuity, CMT, and the total number of injections were documented. Patients were followed-up but data was gathered on baseline and at the 12th month were compared. Results: In comparison to the initial presentation, a significant decrease in CMT was noticed in both groups (163.47±83.60 μm vs. 126.45±52.45 μm, respectively). Moreover, a significant improvement in visual acuity of both groups (p&lt;0.023 and p&lt;0.016, respectively) and significantly fewer injections being required in the second group were noticed. Conclusion: Combining intravitreal bevacizumab with macular grid laser treatment can lead to stabilisation and improvement of visual acuity with a smaller number of injections which was statistically significant.

Intravitreal Ranibizumab Monotherapy or Combined with Laser for Diabetic Macular Edema (OCT guided study)

Background: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes mellitus and the leading cause of blindness in the working age population in developing countries. Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy over Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Both groups achieved improvement of visual acuity and reduction of the macular thickness but the effect was more pronounced and long lasting in the combined therapy group. Conclusion: The use of more than one line of treatment in combination for patients with diffuse DME could provide more sustained results with the need for less frequent injections and decreasing the recurrence or persistence rate of DME.

Intravitreal Ranibizumab Monotherapy or Combined with Laser for Diabetic Macular Edema (OCT guided study)

Background: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes mellitus and the leading cause of blindness in the working age population in developing countries. Objective: The aim of this study was to compare central macular thickness using optical coherence tomography (OCT) between Ranibizumab 0.5 mg monotherapy over Ranibizumab 0.5 mg combined with laser based on mean average change in best-corrected visual acuity (BCVA) over 6 months in diabetic macular edema (DME). Patients and methods: The study was carried out on forty eyes of patients aged 30-75 years old, with type 1 or 2 diabetes mellitus and have visual impairment due to DME. The patients were selected from the Outpatient Ophthalmology Clinic of Aswan University Hospital. Results: Both groups achieved improvement of visual acuity and reduction of the macular thickness but the effect was more pronounced and long lasting in the combined therapy group. Conclusion: The use of more than one line of treatment in combination for patients with diffuse DME could provide more sustained results with the need for less frequent injections and decreasing the recurrence or persistence rate of DME.