Macular Edema In Patients Research Articles

Optical Coherence Tomography Biomarkers in Bilateral Diabetic Macular Edema Patients with Asymmetric anti-VEGF Response

ABSTRACT Background: This study aimed to identify optical coherence tomography (OCT) biomarkers for predicting response to anti-VEGF treatment in diabetic macular edema (DME) Methods: Bilateral DME patients with asymmetric response to a loading dose of anti-VEGF (ranibizumab/aflibercept) treatment were retrospectively studied. The morphologic response criterion was central subfield thickness (CST) ≤300 µm; asymmetric response was defined as ≥10% difference in CST reduction between the eyes. The functional response criterion was an increase in logMAR acuity of ≥3 lines, with an increase below this threshold in the fellow eye considered asymmetric response. Relationships between final morphologic and functional responses to anti-VEGF therapy and baseline values of the following OCT-derived biomarkers were evaluated: DME subtype, CST, vitreoretinal interface anomalies, disorganization of the inner retinal layers (DRIL), external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption, and subretinal fluid (SRF). Results: After a loading dose of anti-VEGF, 31 eyes that met both morphologic and functional response criteria were classified as responders (RR) and 27 eyes that did not respond morphologically or functionally based on the defined criteria were classified as resistant (RT). Eyes that showed only functional (n = 5) or morphological response (n = 1) were excluded due to their small number. The presence of SRF or simple epiretinal membrane (ERM) was not associated with any difference in treatment responses (p > .05), while tractional ERM, extensive DRIL (≥500 µm), and ELM and EZ disruptions in the fovea-centered 1000-µm zone were important OCT biomarkers in predicting resistance (p < .001). A multilayer perceptron model ranked predictive power as 100% for ELM disruption, 51.7% for tractional ERM, 25.4% for DRIL, and 24.5% for EZ disruption. Conclusion: Extensive ELM disruption was the strongest OCT biomarker to predict anti-VEGF resistance, followed by tractional ERM. EZ disruption and DRIL had relatively lower predictive value.

Evaluation of morphological characteristics of diabetic macular edema in patients with non-proliferative versus proliferative diabetic retinopathy: a spectral-domain optical coherence tomography study

To evaluate the morphological characteristics in patients with diabetic macular edema (DME), either with co-existent non-proliferative diabetic retinopathy (NPDR) or with PDR. Retrospective study includes 138 treatment naïve patients with DME, either with NPDR (n = 96) or in combination with PDR (n = 42). All patients underwent best corrected visual acuity (BCVA) measurement, spectral domain-optical coherence tomography (SD-OCT) and fluorescein angiography, while demographic characteristics were also recorded. Specific clinical and morphological characteristics were analyzed and compared between the two groups. Patients with DME and PDR presented higher central retinal thickness and mixed type of edema, with predominantly cystoid component and large cysts, extending in the foveal, peri- and para-foveal area, compared to patients with DME and NPDR. The presence of non-perfusion areas in patients with DME and PDR led to additional ellipsoid zone and external limiting membrane disruption in a higher percentage, accompanied with worse visual acuity compared to patients with DME and NPDR. Patients with DME and PDR had also higher vitreomacular traction percentage and higher HbA1c levels than those with DME and NPDR. Variations in morphological characteristics of DME on SD-OCT existed between patients with NPDR and those with PDR. These differences may explain the alterations in visual acuity and prognosis.

Сравнительная характеристика результатов применения разнонаправленной интравитреальной фармакотерапии в лечении диабетического макулярного отека

Purpose. To conduct a comparative analysis of the effectiveness of intravitreal injection of dexamethasone-containing implant and aflibercept in macular edema in patients with diabetes mellitus. Material and methods. The study involved 80 patients (80 eyes) with macular edema. The group 1 included 38 patients (38 eyes) who underwent a single intravitreal injection of dexamethasone-containing biodegradable implant «Ozurdex» in a dose of 0.7 mg according to the standard technique. In the group 2, 42 patients (42 eyes) received 5 loading doses of aflibercept with an interval of one month. All patients underwent monthly spectral optical coherence tomography (OCT) of the macular area, as well as visometry and tonometry during the observation period. Results. One month after intravitreal injection of the studied drugs in both groups, no inflammatory reactions were detected in any case. According to OCT data, cystic edema of the macular area with a tendency to decrease the thickness in the fovea was preserved. After treatment with aflibercept, the average retinal thickness in the macula was 186.4±15.1 µm, and visual acuity averaged 0.48±0.05 in 85.7% of patients. During therapy with intravitreal injection of Ozurdex, an increase in visual acuity was noted in 89.4% of patients. Conclusion. This study found that intravitreal pharmacotherapy with an angiogenesis blocker and a dexamethasone implant in patients with diabetic macular edema are comparable in its effectiveness – 85.7 and 89.4% respectively. If systematic anti-angiogenesis therapy is not possible for a number of reasons, it is advisable to use a prolonged dexamethasone implant. Key words: macular edema, intravitreal pharmacotherapy, angiogenesis inhibitor, implant with dexamethasone.

Aqueous humor inflammatory cytokine levels and choroidal thickness in patients with macular edema associated with branch retinal vein occlusion.

We aimed to investigate the association between subfoveal choroidal thickness (SCT) and the level of aqueous humor (AH) inflammatory cytokines in patients with macular edema (ME) associated with branch retinal vein occlusion (BRVO). Twenty-eight eyes of 28 BRVO ME patients who underwent intravitreal injection treatment (ranibizumab, bevacizumab, or dexamethasone implant) were prospectively recruited. The concentrations of vascular endothelial growth factor (VEGF)-A and inflammatory cytokines were measured from AH samples. We analyzed clinical factors associated with visual gain or the degree of central macular thickness (CMT) decrease and the association between SCT and inflammatory cytokine levels. On multiple linear regression analysis, the AH interleukin (IL)-8 level was significantly associated with visual gain and CMT reduction at 6months. Age, systemic hypertension, and AH monocyte chemo-attractant protein 1 level showed a significant association with baseline SCT, and VEGF-A showed a significant association with baseline SCT ratio (BRVO eye SCT/fellow eye SCT). Those with thick SCT showed a higher level of AH soluble VEGF receptors 2 and IL-8 and showed better visual gain and greater CMT reduction at 2 and 6months compared to the thin SCT group. The level of AH inflammatory cytokines was significantly associated with the ischemic status of the retina, treatment outcomes, and SCT in BRVO ME patients. Thick baseline SCT might be a predictive sign for better treatment outcomes in BRVO ME patients which are thought to be related to a higher level of intraocular inflammatory cytokines in these patients.

A study conducted in western Maharashtra to evaluate the risk factors for diabetic macular edema in patients with type 2 diabetes mellitus

To study various risk factors (HbA1c levels, dyslipidemia, stroke, smoking, cardiovascular disease, nephropathy and use of pioglitazones) associated with Diabetic Macular Edema in patients with type 2 diabetes mellitus. A total of 110 patients with type 2 diabetic mellitus of age group 30-70 years and both sexes participated in this study. Association between risk factors and diabetic macular edema was studied in analytical cross-sectional study conducted in a tertiary care hospital of Western Maharashtra. Median of HbA1c in patients with macular odema was 8.15(7.8-8.925) which was significantly higher than patients without macular odema 6.4(6-6.825). Mean LDL(mg/dL) in patients without macular odema was 99.1 ± 32.96 and patients with macular odema was 113.29 ± 32.35. Significant association was seen in the distribution of HbA1c(p&amp;#60;0.0001), LDL (p=0.046) and the use of pioglitazone (p = 0.00006) with macular odema. No significant association of stroke, smoking, cardiovascular disease and distribution of nephropathy with macular odema was found.(p value&amp;#62;.05) In patients with type 2 diabetes mellitus, multiple factors such as elevated HbA1c levels, LDL and use of pioglitazones were significant risk factors associated with Diabetic Macular Edema(DME). Also as many of the risk factors are modifiable, ophthalmologists and physicians should ensure that patients with DME receive appropriate assessment and treatment for these comorbidities.

Rapid reduction of macular edema due to retinal vein occlusion with low-dose normobaric hyperoxia.

We investigated the effects of a relatively inexpensive, non-invasive, short-term treatment with low-dose normobaric hyperoxia (NBH) on macular edema in patients with retinal vein occlusion (RVO). Participants with macular edema associated with RVO were treated with 5 LPM of NBH via facemask (40% fraction of inspired oxygen, FIO2) for 3 h. Patients with non-fovea involving edema who elected to be observed returned for a second treatment 1 month later to test reproducibility. A 3-h session of NBH (n = 45) resulted in decreased maximum macular thickness (MMT) (mean 7.10%, t34=9.63 P<.001) and central macular thickness (CMT) (mean 4.64%, t34=6.90, P<.001) when compared to untreated eyes with RVO measured over the same period of time (n = 12) or their healthy fellow eye (n = 34; MMT:t34=-9.60, P<.001;CMT: t34=-6.72, P<.001). Patients who had a second NBH treatment 1 month later experienced a recurrence of their edema, but demonstrated a similar significant reduction in MMT and CMT after the second NBH treatment. Three-hour treatment with 40% FIO2 NBH results in a significant reduction in MMT and CMT. This study supports an ischemic mechanism for macular edema associated with retinal vein occlusion. Short-term low-dose normobaric hyperoxia is a simple, inexpensive, and ubiquitous treatment that may provide an alternate or adjunctive approach to treating macular edema in patients who are resistant to or cannot afford anti-VEGF medications.

Higher levels of circulating ANGPTL2 are associated with macular edema in patients with type 2 diabetes.

Macular edema (ME) is an inflammatory disease characterized by increased microvascular permeability. Here, we proposed that plasma angiopoietin-like protein 2 (ANGPTL2) level may be related to the severity of ME patients with type 2 diabetes mellitus (T2DM). In this cross-sectional study, 172 T2DM patients were recruited and divided into clinically significant macular edema (CSME), non-CSME (nCSME), and control groups. Serum ANGPTL2 level was quantified by ELISA and best corrected vision acuity (BCVA) was detected. After adjust age, sex, body mass index (BMI), and duration of diabetes variables, ANGPTL2 performed statistics difference among CSME-, nCSME-groups, and control group (4.46 [3.97, 4.96, 95%CI] ng/mL in CSME group, 3.80 [3.42, 4.18, 95%CI] ng/mL in nCSME-group, 3.33 [3.03, 3.63, 95%CI] ng/mL in control, P < .01). After adjustment of confounding factors, high levels of circulating ANGPTL2 were related with the diagnosis of ME, BCVA, and C reactive protein (CRP) through univariate regression analysis (P < .05). Meanwhile, in the multiple regression model, ANGPTL2 took the mainly effect proportion for the diagnosis of diabetic macular edema (DME), with a LogWorth value 3.559 (P < .001). Our study suggested that elevated circulating ANGPTL2 may be associated with the development of DME and the severity of visual impairment in patients with type 2 diabetes.

Quantitative assessment of vascular density in diabetic retinopathy subtypes with optical coherence tomography angiography

BackgroundQuantitative assessment of vascular density (VD) of retinal and choriocapillaris (CC) in various stages of diabetic retinopathy (DR) using spectral domain optical coherence tomography angiography (SD OCTA).Methods188 eyes of 97 participants were recruited in this cross-sectional study. The macular OCTA (3x3mm) scan was performed and the computer algorithm assessed VD at the level of superficial capillary plexus (SCP), deep capillary plexus (DCP) and CC.ResultsAll measured parameters were decreased in retinal VD at the more extreme stages of DR, with the exception of SCP foveal VD. There was a constant pattern of decrease in VD of CC from normal cases to cases of NDR and NPDR and then a slight increase occurred in the PDR stage but never touching the normal quantities. Age, fasting blood sugar, and years of diabetes mellitus were correlated with reduced VD in different segments. Multivariate linear regression analysis showed that best-corrected visual acuity (BCVA) was positively correlated with parafoveal VD at SCP and VD of foveal area at CC. VD of all subfields of macular area except foveal DCP VD showed reduced levels in diabetic macular edema (DME) patients compared to those without DME.ConclusionsThe findings of the study endorse retina VD changes as a potential biomarker for DR development before retinopathy becomes clinically evident. It seems that parafoveal VD of SCP and foveal VD of CC are good biomarkers to predict VA in the diabetic patients.

Association Between Obstructive Sleep Apnea and Diabetic Macular Edema in Patients with Type 2 Diabetes

To evaluate the relationship between obstructive sleep apnea (OSA) and diabetic macular edema (DME) and the effect of OSA on refractory DME in patients with type 2 diabetes (T2DM). Retrospective clinical cohort study. A population-based study was conducted at Chang Gung Memorial Hospital from March 1, 2009, to March 1, 2020. Among 14,152 patients who had undergone polysomnography (PSG) and whose data were registered on the sleep center's PSG database, 121 patients (242 eyes) with T2DM were enrolled according to the International Classification of Diseases, Ninth Revision (ICD-9) code 3620 for diabetic retinopathy (DR). Patients with a secondary cause of macular edema and those lacking medical records were excluded. All patients with T2DM enrolled in our study received both optical coherence tomography (OCT) and PSG. The prevalence of severe (apnea-hypopnea index [AHI] ≥30) and nonsevere (AHI <30) OSA was compared between patients with and without DME and refractory DME. In total, 102 eyes (54 patients) were divided into groups of 40 eyes with DME or 62 eyes without DME. Severe OSA (odds ratio, 7.36; 95% confidence interval [CI]: 1.32-40.96; P=.023) was significantly associated with DME. Refractory DME was significantly more frequent in patients with severe OSA (27%) than in those with nonsevere OSA (0%; P=.009). Cox proportional hazards regression analysis revealed that OSA (hazard ratio, 2.97; CI, 1.08-8.16; P=.034) independently increased the DME risk after adjustment for age, sex, glycohemoglobin level, hypertension, and hypercholesterolemia. Severe OSA is a risk factor for DME and is associated with having refractory DME.

Comparison of Intravitreal Bevacizumab versus Intravitreal Ranibizumab in Treatment Naive Macular Edema Patients (Real World Evidence in Pakistan)

Purpose: To compare the short-term efficacy and safety of intraocular Ranibizumab and Bevacizumab in patients with treatment Naïve macular edema.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Amanat Eye Hospital, from August 2018 to November 2019.&#x0D; Methods: Patients with macular edema confirmed with optical coherence tomography (OCT) or leakage on fluorescein angiography were included. Patients with NVE, PDR without macular edema and patients who switched to alternative anti-VEGF compounds prior to the completion of three consecutive monthly injections of their respective anti-VEGF or switched to other treatment options were excluded from the study. A thorough clinical examination was conducted including best corrected visual acuity (BCVA, intraocular pressure (IOP), anterior and posterior segment examination and OCT macula. The patients were then allocated to one of the two study arms (either Bevacizumab or Ranibizumab) based on the doctor’s input and patient affordability. All patients underwent three consecutive injections of the selected molecule at one month intervals. BCVA, CRT and macular volume were then recorded 04 weeks after the third injection.&#x0D; Results: A statistically significant mean vision gain was observed from baseline in both groups (p &lt; 0.05). However, the change in BCVA was not significantly different between intravitreal Bevacizumab group and intravitreal Ranibizumab group (p &gt; 0.05). Similarly, although there was improvement in CRT and macular volume in both groups but there was no statistically significant difference between the two.&#x0D; Conclusions: Treatment with intravitreal Bevacizumab and Ranibizumab injections cause statistically similar anatomical and functional results in cases of treatment naïve macular edema.&#x0D; Key Words: Bevacizumab, Ranibizumab, Macular Edema, Diabetic Retinopathy, Macular Degeneration, Retinal Vein Occlusion.

Efficacy of intravitreal dexamethasone implant as a starting monotherapy and when switching from an anti-VEGF drug in diabetic macular edema

To conduct a comparative assessment of the effectiveness of an intravitreal dexamethasone implant as a starting monotherapy and when switching from anti-VEGF therapy for macular edema in patients with diabetes mellitus. The study involved 112 patients (112 eyes) with diabetic macular edema. The 1st group of the study included 58 patients (58 eyes) with newly diagnosed diabetic macular edema, who had not previously received special ophthalmic treatment. Group 2 included 54 patients (54 eyes) resistant to anti-VEGF therapy after 5 intravitreal injections of aflibercept. All patients underwent monthly spectral optical coherence tomography of the macular region, as well as visometry and tonometry during the follow-up period (6 months). The maximum therapeutic effect in both groups was observed 3 months after intravitreal introduction of the dexamethasone implant - in 94.8% and 92.5% of cases, respectively, it contributed to an improvement in the architectonics of the retinal layers, a decrease in retinal edema and an increase in visual acuity. At the same time, the most pronounced increase in BCVA (on average up to 0.66±0.1) was observed in patients of the 1st group. This study confirmed that an intravitreal dexamethasone implant can be recommended for newly diagnosed diabetic macular edema, as just one injection leads to resolution of macular edema and high functional outcomes, which persisted in 89.6% of study patients throughout the observation period.

Retinal Vein Apoplexy: Pathogenesis, Risk Factors Hematological Disorders and Treatment

Retinal vein impediment (RVO) is the most common retinal vascular sickness after diabetic retinopathy. Attributable to its multifactorial nature, notwithstanding, the board of this condition remains a test. Of the two fundamental kinds of RVO, branch retinal vein impediment (BRVO) is more pervasive than central retinal vein impediment (CRVO). Most patients create the disease at an older age, and the greater parts of them have associated foundational messes (for example hypertension, hyperlipidemia and/or diabetes mellitus). There is no proof to suggest routine testing for heritable thrombophilia’s in patients with RVO. The fundamental driver of the visual debilitation is macular edema, while neovascularization of the retina and optic plate are the most genuine inconveniences prompting glassy hemorrhage, retinal separation and neovascular glaucoma. Macular grid laser photocoagulation is an effective treatment for macularedema in patients with BRVO and a visual keenness of 20/40 or less. Other treatment choices for decreasing the edema are intra vitreal steroids, against VEGF medications and vitrectomy. The recently presented intra vitreal use of steroids and against VEGF medications might end up being a superior methodology for improving visual keenness. At long last, dissipate pan retinal laserphotocoagulationcan effectively treat neovascularization and its secondary complications.

VISUAL OUTCOMES IN PATIENTS WITH DIABETIC MACULAR EDEMA TREATED WITH DEXAMETHASONE IMPLANT IN ROUTINE CLINICAL PRACTICE.

SUMMARYThe aim was to evaluate visual outcomes of the real-life usage of dexamethasone (DEX) implants in diabetic macular edema (DME) patients and evaluate the possible additional visual acuity (VA) gain with combined treatment. We retrospectively reviewed medical records of DME patients treated with DEX implants. The mean best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT) at baseline and one year were compared. BCVA improved from 58.4±14.9 letters at baseline to 62.4±14.5 letters at one-year evaluation (p=0.002). The mean change in BCVA was 5.2±11.1 letters. CRT decreased from 485.7±146.3 µm at baseline to 391.5±129.0 µm at one year (p<0.001). The mean change in CRT was -89.6±143.3 µm. Patients received a mean of 2.0±0.7 DEX implants. Study eyes were also divided into a group receiving DEX implant monotherapy and a group receiving DEX implant and vascular endothelial growth factor inhibitor (anti-VEGF) therapy. Changes in BCVA and CRT and the number of DEX implant injections were compared between the two groups. No difference in VA gain was found between the eyes receiving monotherapy and the eyes receiving combined treatment. In conclusion, DEX implant therapy was effective in gaining vision in DME patients. No additional VA gain was achieved with combined treatment.

Significance of monitoring vascular endothelial growth factor, monocyte chemoattractant protein-1 and Interleukin-8 in diabetic macular edema towards early identification of nonresponders to ranibizumab therapy.

Purpose:Identification of nonresponders prior to anti-vascular endothelial growth factor (anti-VEGF) therapy would help in the judicious clinical management of diabetic macular edema (DME) patients. Thus, a systematic study was initiated to identify nonresponding DME patient population undergoing ranibizumab treatment to figure out additional inflammatory components that may contribute to their nonresponsiveness to anti-VEGF therapy.Methods:A total of 40 patients recruited to this investigator-initiated trial received intravitreal ranibizumab monthly for 3 months. The fourth- and fifth-month injections were according to PRN protocol and the sixth-month injection was mandatory. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and VEGF in aqueous humor were measured for all the patients. Patients were grouped into responders/nonresponders on the formulated criteria and the levels of key pro-inflammatory cytokines were also measured between the two groups at baseline, 2 month and 5 months using cytometric bead array (CBA).Results:Eleven patients were categorized (29.72%) as responders and 10 patients (27.02%) as nonresponders. Nonresponders showed poorer BCVA (P = 0.024, 0.045, and 0.048 for 4, 5, and 6 months) and higher CMT (P = 0.021, 0.0008 and <0.0001 for baseline, 1, 2, 3, 4, 5, and 6 months) compared to responders. The cytokines IL-8, MCP-1 were significantly up regulated (P = 0.0048 and 0.029 for MCP-1 and IL-8) in nonresponders.Conclusion:Elevated MCP-1 and IL-8 levels found in the nonresponders could be used as a prognostic marker to identify these groups of patients and can help in developing alternative treatment options along with anti-VEGF therapy.

Comparison of intravitreal dexamethasone implant and afl ibercept therapy in resistant diabetic macular oedema patients with an infl ammatory phenotype: short term results

Comparison of intravitreal dexamethasone implant and afl ibercept therapy in resistant diabetic macular oedema patients with an infl ammatory phenotype: short term results

Study on Correlation of Visual Acuity and Foveal Thickness in Diabetic Macular Edema Patients

Study on Correlation of Visual Acuity and Foveal Thickness in Diabetic Macular Edema Patients

Incidence of clinical and subclinical macular edema in patients submitted to phacoemulsification in a university health service

Introduction: The incidence of cystoid macular edema (CME) after cataract surgery varies substantially and depending on the diagnostic method used. In addition, other factors that influence the incidence of CME are the technique of surgery and the associated comorbidities. Objective: The aim of the present study was to evaluate the incidence of EMC after uncomplicated phacoemulsification surgery, using the spectral domain optical coherence tomography (OCT). Methods: The incidence of sub-clinical and clinical CME was evaluated in 14 patients who underwent uncomplicated phacoemulsification surgery, using OCT before the surgical procedure and after seven and 28 days after it. The volunteers could not use a prostaglandin analogue or present any retinopathy that compromised visual acuity. Results: The incidence of clinically significant CME was 6.4%, however retinal thickening by OCT was observed in all patients in the fourth postoperative week. Regarding gender and laterality, the percentages were similar. Conclusion: In this study, we obtained a low incidence of EMC in patients assisted at this center, corroborating multicenter studies.

Cystoid macular edema associated with retinitis pigmentosa: clinic, diagnostic, treatment approaches

Retinitis pigmentosa (RP) is a genetically determined degenerative retinal disease characterized by primary progressive degeneration of rod and secondary degeneration of cone photoreceptors. Despite the fact that the central retinal zone remains relatively intact for a long time, the most common complication of RP is macular edema (ME). The causes of ME in patients with RP have not been finally established, and treatment approaches are controversial. This article presents the modern data on the pathogenesis, clinical aspects, diagnostic, and treatment methods of ME associated with RP.

Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those...

Visual outcomes in diabetic macular edema patients after avastin injection

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.