Combined intravitreal triamcenolone acetonide and bevacizumab for refractory diabetic macular edema

To evaluate the effectiveness of combined Intravitreal triamcinolone acetonide (IVTA) and Intravitreal Bevacizumab (IVB) for treatment of refractory diabetic macular edema. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from January to December 2017. Methodology: Pseudophakic diabetic patients with macular edema refractory to prior treatment were included. Patients having best corrected visual acuity (BCVA) better than 20/40 (6/12) or worse than 20/200(6/60) or the central subfield thickness (CSFT) less than 300 um on spectral domain optical coherence tomography (OCT) were excluded. Effectiveness of treatment was compared in terms of change in BCVA and CSFT on OCT. Intravitreal injection of 2 mg IVTA and 1.25 mg of IVB was given. IVB was repeated on monthly basis in next two months. Follow-up was done after one week of first injection and then monthly for next three months. Results: Fifty eyes of 42 patients were studied. Mean age of the patients was 62.4 years +7.13. Male to female ratio was 2:1. Mean pre op LogMAR visual acuity was 0.708 +0.12 and CSFT was 439.10 +54.64 um. Mean postoperative LogMAR visual acuity was 0.586 +0.13 um and mean post op CSFT was 382.80 +56.12. There is statistically significant difference in improvement of LogMAR BCVA and decrease in CSFT after treatment. (p<0.001, paired t test). Conclusion: Eyes with refractory macular edema showed improvement of visual acuity and reduction of CSFT at three months when treated with combined IVTA and IVB. (author)