Photocoagulation Research Articles

Systemic exposure to aflibercept after intravitreal injection in premature neonates with retinopathy of prematurity: results from the FIREFLEYE randomized phase 3 study

BackgroundThere are no data on pharmacokinetics, pharmacodynamics, and immunogenicity of intravitreal aflibercept in preterm infants with retinopathy of prematurity (ROP). FIREFLEYE compared aflibercept 0.4 mg/eye and laser photocoagulation in infants with acute-phase ROP requiring treatment.MethodsInfants (gestational age ≤32 weeks or birthweight ≤1500 g) with treatment-requiring ROP in ≥1 eye were randomized 2:1 to receive aflibercept 0.4 mg or laser photocoagulation at baseline in this 24-week, randomized, open-label, noninferiority, phase 3 study. Endpoints include concentrations of free and adjusted bound aflibercept in plasma, pharmacokinetic/pharmacodynamic exploration of systemic anti-vascular endothelial growth factor effects, and immunogenicity.ResultsOf 113 treated infants, 75 received aflibercept 0.4 mg per eye at baseline (mean chronological age: 10.4 weeks), mostly bilaterally (71 infants), and with 1 injection/eye (120/146 eyes). Concentrations of free aflibercept were highly variable, with maximum concentration at day 1, declining thereafter. Plasma concentrations of adjusted bound (pharmacologically inactive) aflibercept increased from day 1 to week 4, decreasing up to week 24. Six infants experienced treatment-emergent serious adverse events within 30 days of treatment; aflibercept concentrations were within the range observed in other infants. There was no pattern between free and adjusted bound aflibercept concentrations and blood pressure changes up to week 4. A low-titer (1:30), non-neutralizing, treatment-emergent anti-drug antibody response was reported in 1 infant, though was not clinically relevant.Conclusions24-week data suggest intravitreal aflibercept for treatment of acute-phase ROP is not associated with clinically relevant effects on blood pressure, further systemic adverse events, or immunogenicity.ClinicalTrials.gov IdentifierNCT04004208.

Comparison of 2 Different Treatments for Conjunctivochalasis: Plasma-Based Conjunctivoplasty Versus Argon Laser Photocoagulation.

The aim of this study was to compare the clinical outcomes of plasma-based conjunctivoplasty and argon laser photocoagulation techniques used in the treatment of conjunctivochalasis. The study included 119 eyes from 67 patients who underwent plasma-based conjunctivoplasty or argon laser photocoagulation for conjunctivochalasis in our clinic between February 2021 and March 2022. Group 1 included 62 eyes from 35 patients who had plasma-based conjunctivoplasty. Group 2 included 57 eyes from 32 patients who had argon laser photocoagulation. Main outcomes were patient symptoms, the degree of conjunctivochalasis, fluorescein staining score, tear breakup time, the amount of conjunctival shrinkage, and complications. Before surgery, Group 1 had grade 1 conjunctivochalasis in 8 eyes (12.9%), grade 2 in 20 eyes (32.2%), and grade 3 in 34 eyes (54.8%). In Group 2, 9 eyes (15.7%) had grade 1, 21 eyes (36.8%) had grade 2, and 27 eyes (47.3%) had grade 3 conjunctivochalasis ( P = 0.43). At the sixth postoperative month, only 2 eyes (3.2%) in Group 1 had grade 1 conjunctivochalasis, whereas the other cases (96.7%) had no conjunctivochalasis. However, Group 2 had grade 1 conjunctivochalasis in 16 eyes (28.0%), grade 2 in 21 eyes (36.8%), and grade 3 in 2 eyes (3.5%). Conjunctival shrinkage in Group 1 (5.1 ± 1.2 mm) was significantly higher than in Group 2 (3.3 ± 0.9 mm; P < 0.001). Postoperative tear breakup time in Group 1 (10.2 ± 2.1 seconds) was significantly longer than in Group 2 (8.8 ± 2.0 seconds; P < 0.001). Plasma-based conjunctivoplasty demonstrated greater clinical improvement and efficacy than argon laser photocoagulation for the treatment of conjunctivochalasis.

Anatomical outcome of laser treatment alone in aggressive retinopathy of prematurity.

The purpose is to study the anatomical outcome of eyes in aggressive retinopathy of prematurity (AROP), treated with laser photocoagulation alone and to evaluate factors affecting outcomes. Records of consecutive babies diagnosed with AROP, undergoing laser photocoagulation treatment in rural tertiary care centers from October 2016 to January 2021 were reviewed retrospectively. Anatomical outcome at 6 months follow-up was grouped as good in eyes with complete regression and poor in those who developed retinal detachment (stage IV a, IV b, and V). Both groups were compared with respect to the period of gestation, birth weight (BW), age at screening, age at treatment, zone of disease, presence of retinal fibrovascular proliferation (FVP), tunica vasculosa lentis, preretinal bleed, need for supplement laser, and associated systemic risk factors. Of the total of 2468 babies screened, 124 (5.02%) were diagnosed with severe retinopathy of prematurity (ROP), of which 54 (43.5%) lasered AROP babies were analyzed. Mean BW and gestation period of the AROP cohort were 1.43 kg and 31.1 weeks, respectively. Eighty-six eyes (79.6%) had good outcomes with laser photocoagulation alone. Posterior location of disease, presence of FVP, neonatal sepsis, shock, and late screening for ROP were found to be factors associated with poor outcomes. Adequate and timely treatment with laser photocoagulation in AROP can achieve good treatment outcomes in a significant proportion of babies. Although a combined approach using laser, anti-vascular endothelial growth factor and early vitrectomy is better, laser remains a viable treatment option in AROP, especially with limited resources and high risk of loss to follow-up.

Diffuse Unilateral Subacute Neuroretinitis: A Case Report Documenting Transretinal Migration of Nematodes

Abstract Purpose: To report two cases of diffuse unilateral subacute neuroretinitis (DUSN) from northern Iran and to present the sequential imaging. Methods: Two patients with large subretinal nematodes were evaluated and managed in our clinic. Serial fundus photography and optical coherence tomography (OCT) imaging were used to document the course of the disease. Laser photocoagulation was administered to manage the patients. Results: The migration of the nematodes from subinternal limiting membrane space to subretinal space was documented in one case, coinciding with the onset of inflammatory and destructive processes. Both patients were successfully managed using laser photocoagulation alone. Follow-up examinations revealed partial recovery of the outer retinal layers and improvement in visual acuity. Nevertheless, some persistent atrophy in the retinal nerve fiber layer and ellipsoid layer was noted in the final examination. Conclusions: We presented two cases of DUSN from northern Iran, with OCT documentation of transretinal migration in one case. Photocoagulation laser alone is an effective treatment modality in the early stage. The suboptimal final visual acuity appears to be linked to both inner and outer retinal layers’ damage.

An Update on Noninfectious Retinal Vasculitis.

Retinal vasculitis (RV) signifies the inflammation of various retinal vessels. Noninfectious RV differs from infectious RV with regard to its pathogenesis and treatment. It can have varied clinical presentations and may be associated with systemic vasculitic diseases. Noninfectious RV can be caused due to type-III hypersensitivity reactions, increased expression of intracellular adhesion molecules, and genetic susceptibility. Noninfectious RV is primarily classified on the basis of the type of retinal vessels involved. It can be further classified as an occlusive or nonocclusive. RV can be a major association of systemic diseases like Behcet's disease, sarcoidosis and systemic lupus erythematosus. Newer modalities, like ultra-widefield fundus fluorescein angiography, can help in the management of RV. Effective treatment of noninfectious RV requires anti-inflammatory and immunosuppressive therapy. The patients may require treatment with high-dose corticosteroids and biological agents. Anti-vascular endothelial growth factor injections and laser photocoagulation may be indicated to treat the occlusive disease. Prompt treatment may prevent complications like vitreous hemorrhage, neovascular glaucoma, and tractional retinal detachment. The treatment more often requires a multidisciplinary approach. This review provides a comprehensive update on the various causes of noninfectious RV, including both systemic and isolated ocular conditions. It also details various complications and management strategies for this condition.

224 Umbilical cord occlusion of twin reversed arterial perfusion (TRAP) sequence: laser photocoagulation vs radiofrequency ablation

224 Umbilical cord occlusion of twin reversed arterial perfusion (TRAP) sequence: laser photocoagulation vs radiofrequency ablation

Vascular development analysis: a study for tertiary anti-vascular endothelial growth factor therapy after second reactivation of retinopathy of prematurity.

To observe the vascular development results of tertiary anti-vascular endothelial growth factor (anti-VEGF) therapy following spontaneous second reactivation of retinopathy of prematurity (ROP). This retrospective study included 22 infants (42 eyes) with Type 1 or aggressive ROP (A-ROP) who received three anti-VEGF drug treatments for ROP from January 2018 to December 2022. The vascular growth, possible associated risk factors, and the retinal vascularization (DB/DF ratio) were assessed. The mean follow-up was 17.6 months. After the 3rd intravitreal injection, seven eyes showed complete vascularization (Group 1), while the remaining 35 eyes demonstrated persistent avascular retina (PAR) (Group 2). In Group 2, 17 eyes maintained a stable state and were classified in the regression subgroup. The other 18 eyes developed a 3rd reactivation (reactivation subgroup) and were treated with laser photocoagulation (LPC).Birth weight (BW) was significantly lower in Group 2 than in Group 1 (p < 0.001). The decision tree analysis shows that only infants weighing more than 1,250 g (17.50%) had a chance to achieve complete retinal vascularization. The possibility of PAR was higher in patients with BW <1,250 g than ≥1,250 g (70.00% vs. 12.50%). In addition, most infants with BW ≥ 1,290 g and initial ROP disease in Zone I or posterior Zone II developed PAR. Tertiary IVR can successfully treat a second ROP reactivation and improve peripheral retinal vascularization. BW is the most significant factor related to complete retinal vascularization. Our decision tree model may be helpful in predicting the prognosis of anti-VEGF drugs in the event of a second ROP reactivation.

A retrospective study of ophthalmologic presentation, management, and outcomes in pediatric patients admitted with abusive head trauma.

Abusive head trauma (AHT) is a severe form of physical abuse leading to significant morbidity and mortality in children, often presenting with complex brain injuries. Among the varied manifestations, ophthalmologic presentations are critical yet underexplored, which may provide essential clues for early diagnosis and management, improving long-term visual and neurological outcomes. This study aims to explore the manifestation, management, and outcomes of AHT cases within a single center in China over a five-year period, with a focus on the importance of ophthalmologic evaluation in enhancing the diagnosis, management, and outcome predictions of AHT. A retrospective case series was conducted at a single institution, involving infants diagnosed with AHT from 2019 to 2023. Data on demographics, medical histories, and clinical management were collected. Ophthalmologic examinations including fundus photography, ocular B-scan ultrasound and fundus fluorescein angiography (FFA), were performed to evaluate retinal vasculature and identify peripheral ischemic retina (PIR). Statistical analyses were performed using SPSS ver. 26.0. Eight AHT patients (16 eyes) were included in the study. Bilateral ocular involvement was observed in all patients, with 81.25% exhibiting retinal hemorrhages (RH). Other manifestations included retinal detachment (31.25%) and optic nerve atrophy (18.75%). Clinical interventions varied, with 68.75% of patients undergoing treatments such as laser photocoagulation and anti-vascular endothelial growth factor (VEGF) injections. Among all eyes, 75% showed resolution of RH. Despite treatment, some patients progressed to severe conditions such as retinal detachment (RD) and iris neovascularization (INV). This study emphasizes the importance of a multidisciplinary approach in the diagnosis and management of AHT, particularly by integrating ophthalmological perspectives into patient care. These findings contribute to the understanding of ophthalmologic presentations in AHT.

Trophic ulcers of venous etiology and their treatment tactics by endovasal laser coagulation

The main goal of the study was to identify a unified and pathogenetically justified method of surgical treatment of patients with trophic ulcers of venous etiology, as well as an algorithm for preoperative preparation of such patients for minimally invasive intervention. The article presents the results of the treatment of trophic ulcers of venous etiology by endovenous laser coagulation. In a comparative aspect, modern data on its effectiveness are presented, the success of this operation is 93–100 %. When comparing the results of using lasers with different wavelengths and energies, the incidence of severe complications (deep vein thrombosis, thrombophlebitis, pulmonary embolism, skin burn) ranges from 0.1 to 2.4 %. In the analysis of the literature, no evidence was found that the wavelength affects the clinical outcome, but the power of the laser energy used matters. The main elements of preparation and performance of operative interventions aimed at elimination of venous blood reflux in lower extremities are indicated, and therapeutic tactics for healing of soft tissue defect in postoperative period are determined.

Retinal Oxygenation With Conventional 100-ms Versus Short-Pulse Pan-Retinal Laser Photocoagulation.

Conventional (100 ms) pan-retinal photocoagulation (PRP) laser burns are larger than short-pulse (10 ms to 20 ms) PRP burns. This study investigates the effect of PRP burns of different sizes on retinal oxygenation. A mathematical model using COMSOL Multiphysics 6 was used to create a three-dimensional abstraction of the coupled biology of the choroid, photoreceptor, and retinal tissues. Laser burn sizes were varied in the model, specifically considering burn diameters of 500 μm, 250 μm, and 125 μm, while keeping the total burn area constant. Total increase in retinal oxygenation was the same for different burn sizes, but the oxygen distribution differed. Smaller burns resulted in a more even lateral oxygen distribution but with reduced penetration into the inner retina. Conventional and short-pulse PRP may affect retinal oxygenation differently, even when total burn area is the same. Further investigation into optimum burn size and pattern is required. [Ophthalmic Surg Lasers Imaging Retina 2024;55:40-45.].

Efficacy of an Indian Bevacizumab BIOSimilar (BEVATAS) for Type 1 and Aggressive Posterior Retinopathy of Prematurity (BIOS-ROP Study).

To evaluate the role of an Indian bevacizumab biosimilar (Bevatas®), for the management of type 1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP) over 24-weeks. A retrospective, single-center, interventional study of 144 eyes of type 1 (100 eyes) and APROP (44 eyes). All eyes received a single dose of 0.625mg Bevatas injection, and were advised additional laser therapy for suboptimal response. The study population had a mean gestational age of 28.94 (±2.32) weeks, an average birth weight of 1.2 (±0.34) kg, and modest male predominance (52.05%). Complete regression of ROP was seen in 65.97% of 144 eyes after 24 weeks of bevacizumab monotherapy, and in 97.22% of eyes (140 eyes) after adding laser photocoagulation. The remaining four eyes (all had APROP) developed Stage 4 ROP and needed vitreous surgery. After monotherapy with bevacizumab biosimilar, type 1 ROP eyes had significantly higher rate of complete ROP regression than APROP eyes (87% vs 18.18%; P<0.00001). All eyes with type 1 ROP, and 90.91% of eyes with APROP, regressed after receiving additional laser therapy. The study population experienced no ocular or systemic adverse effects. The BIOS-ROP study demonstrates that intravitreal bevacizumab biosimilar monotherapy offers significant benefit for type 1 ROP, but not APROP. Low-cost biosimilars can help sustain healthcare systems in lower-middle income countries (LMICs) with escalating healthcare expenditures. They can also improve healthcare equity by making vision-saving therapies like bevacizumab more affordable and accessible.

Aflibercept or ranibizumab for diabetic macular edema.

Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME. This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography. Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20-74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all P >0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both P >0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both P = 0.001), with no statistically significant difference between groups at all follow-up visits (all P >0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both P = 0.001), with no statistically significant differences between groups at all follow-up visits (all P >0.05). No serious adverse effects were documented in either group. Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naïve DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.

The role of fluorescein angiography in incontinentia pigmenti: A case report

Aims/Purpose: To present the angiographic findings in a case of a 6‐year‐old girl with incontinentia pigmenti.Methods: We describe the case of a 6‐year‐old girl with a known diagnosis of incontinentia pigmenti that presented with retinal vascular changes in a routine ophthalmologic evaluation. Fundoscopic examination revealed a peripheral avascular area with adjacent vascular proliferation. In order to better evaluate these findings, a fluorescein angiography was performed.Results: Angiography findings included abnormal vascular loops, capillary nonperfusion areas and vascular anastomoses. There were also leakage areas (corresponding to active neovascularization) and areas of staining (due to fibrosis). Laser photocoagulation of the peripheral avascular area was done.Conclusions: Incontinentia pigmenti often presents with neovascularization and other vascular changes that are more pronounced in the retinal periphery. Therefore, fluorescein angiography is very valuable in the documentation and study of vascular lesions associated with this condition.

Long-term outcomes of visual motor integration and motor development children with retinopathy of prematurity.

Premature infants have a risk of neurodevelopmental deficits. Little is known, however, about how retinopathy of prematurity (ROP) affects visual motor integration (VMI), which is necessary for both fine motor skills and further school abilities. Due to the systemic escape of bevacizumab in the treatment of ROP, concerns regarding the long-term neurodevelopmental effect of the drug have arisen. The aim is to evaluate VMI and motor development long-term outcomes after intravitreal bevacizumab (IVB) injection and laser treatment for ROP. Two groups of premature children were included: Bevacizumab group - 16 premature children who received IVB treatment and laser group - 23 premature children who underwent laser photocoagulation treatment in this single center cross-sectional study. At 2-6 years of age, VMI (Beery-Buktenica Developmental Test), motor development (Peabody Developmental Motor Scales-2), visual acuity, and refractive status were assessed. The incidence of abnormal visual function was significantly higher in bevacizumab group than in laser group (p = 0.022). The incidence of abnormal VMI skill was significantly higher in bevacizumab group than in laser group (p = 0.024). Incidences of abnormal gross, fine, and total motor skills were significantly higher in bevacizumab group compared to laser group (p < 0.05). Premature children who received bevacizumab for ROP demonstrated significantly lower VMI and motor development features than those with laser treatment at preschool age. Although our results suggest the relevance of bevacizumab injection in impaired VMI and motor development outcomes, general level of sickness rather than treatment might be the cause of delayed motor development.

863 Outcomes after fetoscopic laser photocoagulation for TTTS with or without concomitant selective fetal growth restriction

863 Outcomes after fetoscopic laser photocoagulation for TTTS with or without concomitant selective fetal growth restriction

Development of the refraction and axial length of the eye in preterm infants with retinopathy of prematurity after retinal laser coagulation depending on the age

Development of the refraction and axial length of the eye in preterm infants with retinopathy of prematurity after retinal laser coagulation depending on the age

Пренатальная эхокардиографическая методика спекл-трекинг в исследовании сердца у плодов из монохориальных диамниотических двоен с неосложненным и осложненным течением беременности

Aim: to compare left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) in uncomplicated monochorionic, diamniotic (MCDA) twin pregnancy with twin-to-twin transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) of one fetus and uncomplicated singleton pregnancy. Patients and Methods: the study included 60 pregnant women divided into 2 groups. Group 1 included 25 women with an uncomplicated singleton pregnancy. Group 2 included 35 women with an MCDA twin pregnancy. Pregnancy was complicated with Quintero stage I-III TTTS in 10 women and sIUGR in 10 women. No MCDA twin pregnancy complications were reported in 15 women. Ventricular GLS (by speckle tracking echocardiography) and fetal ejection fraction were measured during the study. Results: significant differences in ventricular GLS were found between fetuses in singleton and uncomplicated MCDA twin pregnancies (for RV, -20.1±2.4 and -23.3±2.5, respectively, p=0.020; for LV, -20.9±2 and -24.5±2.3, respectively, p=0.005); donor and recipient fetuses in TTTS (for LV, -27. 2 [-29.5; -24.6] and -20.6 [-23.1; -17.6], respectively, p=0.005, for RV -26.7 [-30.9; -24.6] and -19.1 [-23.5; -17.9], respectively, p=0.005); recipient fetus before and after fetoscopic laser coagulation (FLC) of placental anastomoses; and twins with sIUGR. Thus, fetal ventricular GLS is greater in uncomplicated MCDA twin pregnancies than in singleton pregnancies. Hemodynamics improve after FLC of placental anastomoses in the recipient fetus in TTTS. sIUGR in MCDA twin pregnancy also affects cardiac function in twins, which requires further study. Conclusions: this paper discusses pilot data on the assessment of fetal cardiac function in MCDA twin pregnancy by speckle tracking echocardiography, which detects early changes in fetal myocardial function and reliably monitors changes in cardiac function over time. KEYWORDS: fetal echocardiography, monochorionic diamniotic twins, fetal surgery, speckle tracking echocardiography. FOR CITATION: Kosovtsova N.V., Markova T.V., Chumarnaya T.V., Gusarova E.O., Pavlichenko M.V., Pospelova Ya.Yu., Solov'eva O.E. Prenatal speckle tracking echocardiography for fetal heart study in uncomplicated and complicated monochorionic diamond twin pregnancies. Russian Journal of Woman and Child Health. 2024;7(3):192–198 (in Russ.). DOI: 10.32364/2618-8430-2024-7-3-1.

망막 혈관 질환에서 원형 RNA의 작용 기전 및 RNA 치료제로서의 가능성

Maintaining and preserving visual function became critical in this aging society. The number of patients with retinal vascular disease such as retinopathy of prematurity, age-related macular degeneration, and diabetic retinopathy is gradually increasing due to increased life expectancy, advancements in the technology of delivering premature babies, and complications due to eating habits. To treat these retinal vascular diseases, surgical intervention such as laser photocoagulation and anti-vascular endothelial growth factor (VEGF) drugs can be considered. However, these treatment options are accompanied by various complications and adverse effects. Thus, new treatments focusing on the pathogenesis of retinal vascular disease need to be developed. Various evidences suggest that circular RNA is involved in the pathogenesis of retinal disease. In this article, we discuss about currently used treatments of retinal vascular diseases and the emerging role of circular RNAs in the pathogenesis of retinal vascular diseases. Therefore, understanding the mechanism of circular RNA regulating retinal disease and developing therapeutics using these circular RNAs may offer novel treatment options to cure retinal vascular disease.

Intravitreal injection of methotrexate in persistent diabetic macular edema: a 6-month study.

Diabetic macular edema (DME) affects approximately 10% of patients with diabetes mellitus. This condition can cause blurred or distorted vision, which significantly affects the quality of life of these patients. We evaluated the therapeutic effects of intravitreal methotrexate (MTX) injections on persistent DME. This prospective interventional case series included patients with confirmed persistent DME that was unresponsive to previous standard treatments. The patients underwent comprehensive eye examinations and macular imaging with optical coherence tomography (OCT). A single intravitreal MTX injection (400 µg MTX in 0.16 mL solution) was administered, followed by patient assessments at 1, 3, and 6 months after injection. Best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), macular thickness (MT), and central subfield thickness (CST) were measured at baseline and post-injection to evaluate treatment efficacy. We included 33 eyes of 30 patients with a mean (standard deviation [SD], range) age of 62.7 (8.3, 44 to 77) years, of whom 17 (56.7%) were men and 13 (43.3%) were women. All participants had type 2 diabetes mellitus, with a mean (SD, range) duration of 17.0 (6.8, 10 to 31) years. Most participants (n = 27 eyes, 81.8%) had non-proliferative diabetic retinopathy, and six eyes (18.2%) had regressed proliferative diabetic retinopathy. Four eyes (12.1%) had undergone prior macular laser photocoagulation. The mean (SD) number of prior intravitreal bevacizumab injections was 3.4 (0.8), and 29 eyes (87.8%) had received one intravitreal triamcinolone injection. During the study period, a statistically significant difference was observed in CST (P < 0.05); however, no statistically significant differences were observed in BCDVA, MT, or IOP (P > 0.05). Pairwise comparison revealed a significant decrease in CST at 6 months post-injection compared to the baseline value (P < 0.05). During the investigation period, no side effects of MTX, such as macular edema, retinal tears, vitreous hemorrhage, endophthalmitis, or vision loss, were observed. A single intravitreal MTX injection significantly reduced CST in patients with persistent DME, without relevant safety concerns. However, no significant improvement in functional outcomes was observed. Therefore, there is no strong evidence to recommend its use as a treatment for pDME. Further studies, preferably randomized clinical trials with long-term follow-ups, are warranted to assess the long-term efficacy, safety, and potential benefits of intravitreal MTX for the treatment of persistent DME.

Effect of Intravitreal Injection of Bevacizumab with Laser Photocoagulation versus Combination of Intravitreal Injection of Bevacizumab with Triamcinolone Acetonide in the Treatment of Diabetic Macular Edema

Background &amp; Objective: Recently there are various treatment modalities for the patients of diabetic macular edema. So, it is very difficult to choose the option. This study was aimed to compare the efficacy of combination of intravitreal injection of bevacizumab with laser photocoagulation versus combination of intravitreal injection of bevacizumab with triamcinolone acetonide in the treatment of DME. Methods &amp; Materials: A prospective observational study was conducted on 50 eyes of fifty patients who were diagnosed with DME at vitreo-retina department of NIO&amp;H. They were divided into 2 groups, Group A (treated with bevacizumab with laser photocoagulation) and Group B (treated with intra-vitreal bevacizumab with triamcinolone acetonide). Follow-up pattern was set after 1 and 3 months of intervention. All the baseline data and outcome data were recorded in a pre-designed data collection sheet and was statistically analyzed by SPSS version 23. Result: Mean baseline BCVA was 0.57±0.29 (SD) Log MAR in group A and 0.70±0.26 (SD) Log MAR in group B (p=0.57). BCVA was 0.40±0.32 (SD) and 0.40±0.37 (SD) in group A and 0.58±0.28 (SD) and 0.45±0.36 (SD) in group B during 1st and 2nd follow-up respectively. Comparison of mean BCVA between two groups at final follow-up was not significant. Improvement of CMT from baseline in every follow up in each group was significant but comparison of mean CMT between two groups at final follow-up was not significant (p=0.64). Though the difference of baseline IOP of both groups are statistically significant, comparison of mean IOP between two groups at final follow-up was not significant (p=0.67). Conclusion: There was significant improvement in mean BCVA and mean CMT within the group in each follow-up. At final follow-up, Combination of intravitreal bevacizumab and triamcinolone acetonide shows better improvement which is non-significant. TAJ 2023; 36: No-2: 179-184