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S. P. Mahesh, J. Mathura, Jr.; Comparison of Single versus Combination Therapy in Patients With Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4264.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the characteristics of patients requiring multiple modality (anti-VEGF agents, focal laser photocoagulation and steroids) versus single modality therapy in the treatment of diabetic macular edema.
A retrospective chart analysis of 21 patients (n=30 eyes) with Diabetic macular edema with a minimum follow up of 180 days was done. Patients who had undergone treatment were analyzed in three different groups- group 1 (focal laser photocoagulation or intravitreal bevacizumab), group 2, a combination of two of the three different modalities (focal laser photocoagulation or intravitreal triamcinolone or intravitreal bevacizumab), group 3, a combination of all three modalities. The retinal thicknesses both prior to and after treatment were analyzed by optical coherence tomography (OCT) among the different groups.
The mean age of the patients was 67 yrs (range 51-86yrs). The mean follow up for the three groups were Group-1 16.1 months, Group-2 15.2months and Group-3 22.4 months respectively. The severity of the disease index was higher in the combination treatment group compared to the single therapy group as evidenced by higher central subfoveal thickness (Group- 319 µ, Group2-336 µ, Group-3 349 µ) and persistence of the retinal edema. There were no statistically significant changes in the retinal thickness among the three different groups after treatment as measured by OCT. The mean changes in retinal thickness for the different groups were Group 1 (-73µ), Group 2(-42µ), and Group 3 (-71µ) respectively. The percentage change in thickness for the three different groups were Group-1 (-21%), Group-2 (-16%) and Group-3 (-13%) respectively.
Single therapy maybe sufficient in patients with diabetic macular edema presenting with initial lower central subfoveal thickness while combination therapy may be beneficial in patients with more severe disease index.
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