Treatment Of Diffuse Diabetic Macular Edema Research Articles

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.

Efficacy of dexamethasone intravitreal implant for the treatment of persistent diffuse diabetic macular edema.

To investigate the efficiency and safety of a single injection of intravitreal dexamethasone implant in eyes with persistent diffuse diabetic macular edema (DME). In this retrospective study, 25 eyes of 20 patients, who underwent a single injection of intravitreal dexamethasone implant for the treatment of persistent diffuse DME, were reviewed. Main outcome measures included the changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline at scheduled visits following injection. The mean BCVA showed improvement from baseline (0.97±0.26 logMAR) at every visit; the difference was significant at day 7 (0.85±0.3 logMAR, p=0.003), month 1 (0.77±0.32 logMAR, p<0.001), month 3 (0.77±0.34 logMAR, p=0.001), and month 4 (0.85±0.31 logMAR, p=0.014). The mean CMT was significantly lower than baseline (616±132μm) at day 1 (518±144μm), day 7 (414±134μm), month 1 (306±95μm), month 3 (339±88μm), month 4 (420±116μm), and month 6 (494±128μm) following the injection (p<0.001, for all). Thirteen eyes on the 4-month follow-up and ten eyes on the 6-month follow-up experienced recurrence of macular edema requiring retreatment. No serious ocular and systemic adverse events were observed. In patients with persistent DME, switching to intravitreal dexamethasone implant injection provides functional and anatomical improvement, and might be an effective therapeutic option for long-standing diffuse DME.

Visual acuity and central macular thickness comparison between posterior sub‐Tenon's capsule triamcinolone injection and vitrectomy for diffuse diabetic macular oedema

AbstractPurpose To compare the effect of posterior sub‐Tenon's capsule triamcinolone acetonide injection (STTA) with the surgical outcomes of pars plana vitrectomy (PPV) for diffuse diabetic macular edema (DME).Methods The medical records of 52 patients (52 eyes) with diffuse DME were reviewed. 26 eyes underwent STTA (20mg) and other 26 eyes – vitrectomy combined with cataract surgery. The central macular thickness (CMT) measured by OCT and best‐corrected visual acuity (BCVA) were examined before and 1, 3, and 6 months after treatment. Statistical analysis was performed with student t‐test, Mann‐Whitney U‐test and repeated measured ANOVA.Results Preop BCVA was 0.65±0.4 logMAR units in the STTA group and 0.77±0.3 logMAR units in the PPV group. One, 3 and 6 months postop BCVA were 0.59±0.4, 0.53±0.5 and 0.47±0.4 in the STTA group and 0.77±0.3, 0.59±0.4, and 0.59±0.4 in the PPV group. Preop CMT were 608.1±220μm in the STTA group and 534.4±157μm in the PPV group. One, 3 and 6 months postop CMT were 392.1±193μm, 284.4±101.7μm and 331.4±121μm in the STTA group and 386.8±175μm, 354.2±101.7μm and 354.2±156.4μm in the PPV group. The differences in the BCVA and the CMT between two groups were not significant at any periods before and after treatment.Conclusion Although STTA and PPV can significantly improve the BCVA and reduce the CMT in patients with diffuse DME, the differences in the BCVA and the CMT were not significant. Considering the minor invasion, STTA can be the first choice for the treatment of diffuse DME.

Nine-month results of intravitreal bevacizumab versus triamcinolone for the treatment of diffuse diabetic macular oedema: a retrospective analysis

To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.

Treatment of diffuse diabetic macular oedema using steroid eye drops

To evaluate the efficacy of treatment of diffuse diabetic macular oedema (DME) with difluprednate ophthalmic emulsion 0.05% (Durezol™) in eyes before vitrectomy. This study enrolled patients with diffuse DME for whom more than 3 months had passed since prior treatment. Nineteen eyes in 15 subjects were treated with difluprednate ophthalmic emulsion 0.05% four times daily for the first month and then twice daily for 2 months (treatment group). As a control group, 22 eyes in 11 subjects with DME were selected from subjects who underwent the steroid responder test. In the treatment group, the mean visual acuity (VA) (±SD) was 0.38 ± 0.25 logMAR and mean retinal thickness was 461.1 ± 109.9 μm at baseline. After 1 month of treatment, the mean VA had improved to 0.29 ± 0.25 (Wilcoxon rank-sum test, p = 0.30), while mean retinal thickness had decreased to 372.1 ± 70.0 μm (p = 0.006). The rate of effective improvement in retinal thickness was 42% and that of VA was 26%. In the control group, changes in neither VA nor retinal thickness were significant. Eye drop therapy using difluprednate ophthalmic emulsion 0.05% is a useful and effective treatment modality without surgical intervention or severe side-effects.

Intravitreal triamcinolone for diffuse diabetic macular oedema

To evaluate the efficacy of intravitreal triamcinolone (IVTA) for the treatment of diffuse diabetic macular oedema (DME) refractory to conventional argon macular laser therapy. A prospective, consecutive, and noncomparative case series was undertaken involving 38 eyes of 38 patients with refractory DME. Triamcinolone acetonide (4 mg) in 0.1 ml was injected intravitreally. LogMar visual acuity (VA) and macular thickness measured by ocular coherence tomography (OCT) were assessed preoperatively and postoperatively at 1, 3, and 6 months. All patients completed 6 months of follow up. VA (mean+/-SD) improved from 0.905+/-0.23 to 0.605+/-0.28, 0.555+/-0.29, and 0.730+/-0.30 at 1, 3, and 6 months, respectively. Macular thickness baseline (mean+/-SD) on OCT was 418.7+/-104.2 microm and this decreased to 276.9+/-72.6 microm, 250.6+/-53.1 microm, and 308.8+/-87.3 microm at 1, 3, and 6 months, respectively. IVTA may be a potential temporary treatment for refractory DME. It is effective in decreasing macular thickness and improving VA but the effect lasts approximately for 6 months in the majority of patients. Further investigations are required to establish the safety of IVTA for the treatment of DME.