July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Comparing intravitreal bevacizumab, sub threshold macular laser (STML) and intravitreal dexamethasone implant (0.7mg) in the initial treatment of diabetic macular edema (DME) in a resident led clinic.
Author Affiliations & Notes
  • Mansoor Mughal
    Ophthalmology, Nassau University Medical Cent, East Meadow, New York, United States
  • Eileen Chang
    Ophthalmology, Nassau University Medical Cent, East Meadow, New York, United States
  • John Matthew Alexander
    Ophthalmology, Nassau University Medical Cent, East Meadow, New York, United States
  • Marcelle M Morcos
    Ophthalmology, Nassau University Medical Cent, East Meadow, New York, United States
  • Footnotes
    Commercial Relationships   Mansoor Mughal, None; Eileen Chang, None; John Alexander, None; Marcelle Morcos, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3681. doi:
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      Mansoor Mughal, Eileen Chang, John Matthew Alexander, Marcelle M Morcos; Comparing intravitreal bevacizumab, sub threshold macular laser (STML) and intravitreal dexamethasone implant (0.7mg) in the initial treatment of diabetic macular edema (DME) in a resident led clinic.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3681.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Comparing intravitreal bevacizumab, sub threshold macular laser (STML) and intravitreal dexamethasone implant (0.7mg) in the initial treatment of diabetic macular edema (DME) in a resident led clinic. Comparison of three different approaches to the initial treatment of DME (Diabetic macular edema) in an initial pilot study. As cost and efficacy is extremely important in the setting of a public county hospital, we are comparing the efficacy of these treatments in our population.

Methods : Data collected on 25 eyes using retrospective chart review of patients presenting to the resident led Retina clinic with new onset DME. All patients received an initial baseline OCT with measurement of the central macular thickness (CMT), followed by either an intravitreal injection of bevacizumab, underwent sub threshold macular laser (STML – Iridex 532) , or were treated with intravitreal dexamethasone 0.7mg implant, with 1 month follow up. Response was monitored by change in BCVA and CMT.

Results : Total of 25 eyes received treatment with intravitreal injection of bevacizumab or sub threshold macular laser for new onset DME. Average preinjection CMT ranged from 310 to 705 in the injection group, with results suggesting an improvement in CMT of 220 to 402, representing 42% reduction in CMT (p<0.01). Average improvement in BCVA was 2 lines or better (p<0.02). In the subthreshold laser group response was not always present with 7 eyes in which CMT increased following treatment, and in those eyes in which there was an improvement, CMT changed from baseline only 12% (p<0.01). In the ozurdex group, improvement was slow but sustained over a 3 month period, however in 2 of 5 eyes there was an increase in intraocular pressure requiring additional IOP lowering medication.

Conclusions : In the resident led clinic, intravitreal injections are highly effective in the initial treatment of DME with excellent reduction in CMT, and BCVA compared to sub threshold macular laser, and intravitreal dexamethasone 0.7mg implants. Initial data from long term follow up however shows further reduction in CMT in the sub threshold laser group and intravitreal dexamethasone group, and shows promise as an adjunctive treatment for the long term management of DME.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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