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ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 336-443

Intravitreal bevacizumab with prompt laser compared with steroid with prompt laser and prompt laser alone for treatment of diffuse diabetic macular edema


1 Department of Ophthalmology, Benha University, Benha, Egypt
2 Magrabi Eye Hospital, Al-Madina Al-Munawara; Zagazig Ophthalmology Hospital, Kingdom of Saudi Arabia

Correspondence Address:
Dr. Amro M Abdel-Galil
Magrabi Eye Hospital, Al-Madina Al-Munawara
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bmfj.bmfj_43_16

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Aim The aim of this study was to compare the efficacy of combined intravitreal bevacizumab injection plus prompt laser versus combined intravitreal triamcinolone injection plus prompt laser and laser alone in the management of diffuse diabetic macular edema on both central macular thickness (CMT) and visual acuity. Patients and methods Sixty patients with diabetes mellitus (type 2) with diffuse macular edema (35 males and 25 females) were recruited for this prospective, randomized, interventional study. Complete history taking, full ophthalmological examination, and CMT measurement using optical coherence tomography were done for all patients. They were subdivided randomly into three groups: laser photocoagulation group (laser group), combined laser and intravitreal bevacizumab group (IVB+laser group), and laser and intravitreal triamcinolone acetonide group (IVTA+laser group), and they were followed up every 2 months for 1 year for evaluation of their response to these treatment modalities as well as for detection of any adverse effects. Results After 12-month follow-up, IVB+laser group showed a higher significant decrease in CMT than that occurred with the other two groups (P<0.0001). However, the laser-treated group showed the least significant change in CMT than baseline. In addition, the visual acuity letter score showed a significant improvement in the IVB+laser group (P˂0.008) than the IVTA+laser group (P<0.048). Compared with the laser-treated group, the most commonly recorded adverse effects during the period of follow-up were increased intraocular pressure and accelerated cataract formation with the need for surgery, with the highest incidence of these complications in the IVTA+laser group than the other two groups. Conclusion Combined IVB+laser photocoagulation provided the highest and the longest efficacy in improving visual acuity and reducing CMT in treating diabetic macular edema, compared with laser group or combined IVTA+laser.


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