The results of intravitreal anti-vegf in diabetic macular edema

Objective : To evaluate the effects of intravitreal ranibizumab (IVR) monotherapy and intravitreal ranibizumab + intravitreal triamcinolone (IVR + IVTA) combination therapy on best-corrected visual acuity (BCVA) and central foveal thickness (CFT) in the treatment of diabetic macular edema (DME). Materials and Methods: This retrospective study included 52 eyes of 37 patients with "clinically significant macular edema" according to the ETDRS classification and with a CFT > 300 μm. All patients were initially treated with intravitreal injection of 0.5 mg/0.05 cc ranibizumab. Patients were called for monthly follow-up visits. Intravitreal 0.5 mg/0.05 cc IVR + 2 mg/0.05 cc IVTA combination therapy was performed in 16 eyes with no change in CFT and no improvement in BCVA after 2 consecutive monthly injections of ranibizumab,. BCVA and CFT values were recorded before and after injections at 1st, 3rd, and 6th month follow-up visits. The t-test was used for data comparison, and a p-value < 0.05 was considered as statistically significant. Results: The mean age of the patients was 60.7 ± 9.2 years. The mean BCVA value was 0.68 ± 0.42 logMAR before injection and 0.54 ± 0.42 logMAR, 0.58 ± 0.44 logMAR, and 0.59 ± 0.40 logMAR at 1st, 3rd, and 6th month after injection, respectively. There was a statistically significant increase in BCVA at 1st and 3rd months compared to the pre-injection values (p < 0.05), but the increase in BCVA at 6th month was not statistically significant (p > 0.05). The mean CFT values before injection were 557.4 ± 157.7 μm and 359.7 ± 154.5 μm, 449.8 ± 202.8 μm, and 446.0 ± 209.3 μm at 1st, 3rd, and 6th month after injection, respectively. A statistically significant decrease in CFT was observed in all post-treatment follow-up visits compared to preoperative CFT (p < 0.05). The comparison of patients treated with IVR monotherapy and IVR + IVTA combination therapy revealed that the mean BCVA values were 0.60 ± 0.41 logMAR and 0.58 ± 0.38 logMAR, and the mean CFT values were 419.35 ± 205.5 μm and 487.0 ± 215.5 μm at 6th month,, respectively. There was no statistically significant difference between the two groups in terms of BCVA and CFT (p > 0.05). Conclusion: Intravitreal ranibizumab monotherapy is effective in improving BCVA and reducing CFT in DME. IVR + IVTA combination therapy may increase the effectiveness of treatment in cases of resistant DME where intravitreal ranibizumab monotherapy is insufficient. Keywords: Diabetic macular edema; ranibizumab; triamcinolone acetonide; resistant diabetic macular edema; intravitreal injection.