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A. Raskin, M. Harasawa, G. A. B. Pereira, V. C. C. Afonso, G. Z. Ramos, L. F. Q. S. da Silveira, C. Moreira, A. F. Bordon; Triple Therapy for Diabetic Macular Edema: Intravitreal Bevacizumab, Triamcinolone Acetonide and Macular Photocoagulation: A Pilot Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4234.
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to evaluate the changes in best-corrected visual acuity (BCVA) with the use of intravitreal bevacizumab (IVB) associated with intravitreal triamcinolone acetonide (IVTA) followed by laser photocoagulation and the changes on central macular thickness (CMT) measured by ocular coherence tomography (OCT).
Inclusion criteria:eyes with diabetic macular edema, BCVA < or = 20/40 and > or = 20/800 and CMT measured by OCT > or = 250 mm. Main exclusion criteria: proliferative diabetic retinopathy and hard exsudates in the fovea. All patients were submitted to ophthalmological examination, fluorescein angiography (FA) and OCT testing. BCVA measurements was performed using the ETDRS charts, slit-lamp biomicroscopy, IOP measure and fundus examination were performed at baseline, one and seven days after injections, 1 and 3 months after and 45 days thereafter. FA and OCT were performed at baseline, D30, D90, D135, D180, D225, D270 and D360. At baseline, patients received 0.05 ml IVB and 0.05 ml (2mg) of preservative-free IVTA. Laser photocoagulation was performed seven days after the injections. IVB was given every 45 days thereafter. IVTA and laser photocoagulation were given every 90 days when CMT remained > or = 250 mm and IOP lower than 24 mmHg.
Sixteen eyes (14 patients) were enrolled. The mean follow up was 113 days (30 - 135). Mean age was 63.2 years old (range, 47-81). Baseline results: mean BCVA was 0.69 logMar (range, 0.3 - 1.0), mean read letters was 18.6 (range, 1 - 39) and mean CMT was 365 mm (260-627mm). D30 results: mean BCVA was 0.62 (0.1 - 1.0), mean read letters was 21.8 (1-54) and mean CMT 313mm (range, 254-526mm). D90 results: mean BCVA was 0.63 (0.1 - 1.0), mean read letters was 20.9 (1-49) and CMT was 325mm (257-500mm). D135 results: mean BCVA was 0.52 (0.0 - 0.9), mean read letters was 28 (8-37) and mean CMT was 313mm (251-357mm). Statistical analysis of the BCVA and number of letters read showed no difference between baseline and D30 or D90, but reached statistical significance on D135 (p=0.003). Regarding the CMT, there was no statistical difference between baseline and D90 or D135, but on D30, CMT was significantly thinner (p=0.009). No ocular or systemic adverse effect was recorded during the study period.
The use of intravitreous bevacizumab with intravitreous triamcinolone and laser photocoagulation showed 30 days after initial treatment improvement in CMT. However visual acuity started to improve later on, 135 days after initial treatment.Long term results are warranted.
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