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Analisa Raskin, Arnaldo F. Bordon, Gabriela A. Pellegrini, Mariana Harasawa, Luiz Felipe Q. Silveira, Natália P. Moreno, Janaína Souza, Gabriel A. Carlos; Triple Therapy For Diabetic Macular Edema: Intravitreal Bevacizumab, Triamcinolone Acetonide And Macular Photocoagulation: Long-term Follow-up. Invest. Ophthalmol. Vis. Sci. 2011;52(14):566.
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Evaluate the changes in best-corrected visual acuity(BCVA) with the use of intravitreal bevacizumab(IVB)and intravitreal triamcinolone acetonide(IVTA) followed by laser photocoagulation and the changes on central macular thickness(CMT) on OCT.The secondary objective is to compare patients divided in 2 groups:IVTA needed and non-IVTA needed
Eyes with diabetic macular edema, ETDRS-BCVA between 20/40 and 20/800 and CMT ≥ 250 µm were included.A complete ophthalmological examination, fluorescein angiography (FA) and OCT were performed.Follow-up testing were done at baseline, D30, D90 and every 45-day after until D405.At baseline, patients received 0.05 ml IVB and 0.05 ml (2mg) of IVTA.Laser photocoagulation was performed 7 days after the injections. IVB was given every 45 days thereafter.IVTA and laser were given when CMT remained ≥ 250 µm and IOP<24 mmHg.After baseline,patients were divided into 2 groups:one received IVTA as needed and the other didn't.
Thirty four eyes (25 patients) were enrolled. The mean follow up was 291 days(180 - 405).Mean IOP at baseline was 13mmHg(9-23) and at last follow-up 16mmHg(10-32).Baseline results:mean BCVA was 0.63 logMar(range, 0.3-1.0), mean read letters was 21.8(range, 1 - 41)and mean CMT was 344 µm(274-627µm).D30 results:mean BCVA was 0.6 (0.0-1.0),mean read letters was 23.7 (1-54) and mean CMT 276µm (range, 210-526µm).D90 results:mean BCVA was 0.5 (0.1-1.0),mean read letters was 24.5 (1-49) and CMT was 297µm (181-519µm).D180 results:mean BCVA was 0.6 (0.2 - 1.0),mean read letters was 22.9 (1-45) and CMT was 269µm (189-542µm).Last follow-up results:mean BCVA was 0.52 (0.2-1.0),mean read letters was 22,4(2-43)and mean CMT was 252µm(122-500µm).Statistical analysis of the BCVA reached statistical significance on D30(p=0.005) and D90(p<0.001) and number of letters read on D30(p=0.015).On CMT, there was no statistical difference between baseline and other follow-up day.Comparing the 2 groups,CMT was significantly thinner on D90 (p=0.033) in the IVTA-needed group, however there was no statistical significance in the remaining follow-up analysis on CMT or BCVA. No ocular or systemic adverse effect was recorded during the study period.No patients needed filtering surgery
The use of IVB with IVTA and laser photocoagulation showed 30 and 90 days after initial treatment improvement in BCVA. The use of IVTA reduces CMT in the short term but it does not improve visual acuity
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