Pretreatment clinical variables associated with the response to intravitreal bevacizumab [Avastin] injection in patients with persistent diabetic macular edema

The purpose of the study is to determine whether the pre-treatment clinical systemic variables and optical coherence tomography [OCT] findings are associated with the subsequent response to the intravitreal bevacizumab [IVE] in eyes with persistent diabetic macular edema [DME]. Prospective, interventional non-comparative case series study. 38 patients [45 eyes] with refractory diabetic macular edemas; 16 females, 22 males with a mean aged 57.5 year. All patients had persistent DME not responded to other forms of treatments. Complete eye examination; best corrected visual acuity [BCVA] [represented as LOGMAR for adequate statistical analysis], slit-lamp exam, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, and morphologic patterns of diabetic macular edema demonstrated by OCT. All patients had intravitreal injection of 0.05 mL = 1.25 mg bevacizumab [Avastin; Genentech, Inc., San Francisco, CA], and were followed up for 3 months. The pre and post-injection follow-up data were analyzed by Student-t test and Mann-Whitney test for two main outcome measures; visual acuity [LOGMAR] and central foveal thickness [CFT] changes over a period of three months, and the data included demographic factors, type, duration and the control of diabetes mellitus [HbA1C%], grade of diabetic retinopathy, renal function [serum creatinine level], serum cholesterol, blood pressure control and previous treatment by focal laser and/or intravitreal triamcinolone injection. The LOGMAR and central foveal thickness [CRT] improved 30/45 eyes [67%] and 32/45 eyes [72%], respectively during a mean follow-up time of three months. The mean LOGMAR visual acuities were 0.64 [SD +/- 0.34], 0.60 [SD +/- 0.32] at pre-injection, at 1 month post-injection and at 3 months post-injection, respectively; but this mean increase in vision was statistically not significant [P value = 0.099]. The mean foveal thicknesses were 444.95 micro m [SD +/- 127.36], 394.95 micro m [SD +/- 138.03] and 378.32 micro m [SD +/- 112.01] at pre-injection, 1 month post-injection and 3 months post-injection, respectively, this decrease in the foveal thickness was statistically significant [P value <0.001]. The pre and post-injection values of the variables for diabetic duration, diabetic control [HbA1c] and OCT pattern of macular edema showed significant statistical correlations [P <0.05] with LOGMAR only, however the values of the variables for serum creatinine and cholesterol show statistical correlation [P <0.05] with both LOGMAR and CFT. Chronicity and inadequate control of diabetes mellitus, nephropathy, hyperlipidemia and presence of vitreomacular attachment [VMA] are factors associated with poor vision progress after intravitreal bevacizumab injection

Intravitreal injection of triamcinolone acetonide for the treatment of refractory diabetic macular edema

A prospective descriptive / non-comparative pilot study was used to evaluate the efficacy of intravitreal injection of triamcinolone acetonide [TA] for the treatment of patients with refractory diabetic macular edema that had not responded to laser treatment. Forty eyes of 35 patients with visual acuity [VA]