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G. D. Pappas, C. I. Adam, E. Papageorgioy, N. Kefalogiannis, H. Fanouriakis; Triamcinolone and Grid Laser versus Bevacizumab Alone for the Treatment of Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3483.
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Diabetic macular edema can lead to a significant reduction of the visual acuity. It occurs in 9% of patients. For many years the gold standard treatment has been focal laser photoquagulation. However only a small number of patients experienced improvement of vision more than two lines in the ETDRS scale. The aim of this study is to compare the efficacy of the intravitreal Triamcinolone in combination with Laser photoquagulation versus the intravitreal Bevacizumab alone for the treatment of diabetic MO.
Patients with clinically significant diabetic macular edema were recruited and randomized in two groups. Group1: treated with 4mg intravitreal Triamcinolone and 3 weeks later underwent focal, grid or modified grid laser photoquagulation. Group2: treated with 1.25mg intravitreal Bevacizumab. BCVA, fundoscopy, OCT macular thickness map performed at baseline, one, three and six months after treatment. Patients previously treated for macular edema, macular ischaemia, vitreomacular traction, epiretinal membrane or undergone intraocular surgery within the last six months were excluded. Ethics committee approval and informed consent forms were obtained.
35 eyes (30 patients) of the group1 and 27 eyes (26 patients) in the group2 completed six months follow up appointments. In the first group only three eyes (8.5%) required a second injection. In the second group only 3 eyes (11%) required 1 injection only. The majority of the eyes required more than two injections. Mean macular thickness reduction was much more impressive in the first group (176.14±46µm) comparing to the second group (87.38±21µm). This difference was statistically significant (p≤0.001). No serious ocular or systemic side effects were observed in either group.
Primary intravitreal injection of Bevacizumab can reduce macular thickness in patients with diabetic macular edema. Though this treatment requires more than one injection and the effect wears off after one month. Treating a patient with Triamcinolone and Laser photoquagulation the effect is much more impressive and the duration longer.
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