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Combined vitrectomy and intravitreal injection versus combined laser and injection for the treatment of intractable diffuse diabetic macular edema

Session Details

Session Title: Vascular Diseases III

Session Date/Time: Sunday 29/09/2013 | 08:00-10:00

Paper Time: 09:20

Venue: Hall 3 (Level 0)

First Author: A.Saeed EGYPT

Co Author(s):                  

Abstract Details

Purpose:

To compare the safety and the efficacy of combined vitrectomy and intravitreal triamcinolone acetonide (IVTA) and bevacizumab (B) injection with that of IVTA and B injection and subsequent macular grid laser photocoagulation for the treatment of intractable diffuse diabetic macular edema.

Setting:

Ophthalmology department, Benha University,and Ebsar eye center, Benha, Egypt.

Methods:

This randomized controlled clinical trial included 34 eyes of 34 diabetic patients diagnosed with intractable diffuse diabetic macular edema (DME) without vitreomacular traction. The patients were divided into two groups. In group I, pars plana vitrectomy with removal of the posterior hyaloid was performed, and at the end of the procedure, IVTA (0.1 ml, 40 mg/m) and B (1.25mg) were injected. In group II, macular grid laser photocoagulation was performed 2 weeks after the same intravitreal injection combination as used in group 1. The main outcome measures were best corrected visual acuity (BCVA) and the central foveal thickness (CFT) which were measured using optic coherence tomography (OCT) at 3, 6, and 12 months.

Results:

The changes in both BCVA and CFT at 3, 6 and 12 months from baseline were highly statistically significant (P <0.01). The mean BCVA was better in group I at 3 months, nearly equal at 6 months, and less at 12 months. The mean CFT was more improved in group I than II at 3 months, and was better in group II at subsequent measurement points. The major adverse events were the development of cataract (more in group I) and elevation of intraocular pressure (more in group II).

Conclusions:

The combined therapy described here could represent a solution for the treatment of intractable DME, and could have a favorable long-term outcome. Combined treatment of intravitreal TA and B plus grid laser resulted in a more favorable CFT reduction and BCVA improvement at 12 months than vitrectomy combined with the same injections. This small study favors the safer, cheaper, and more available line of treatment.

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