Mono therapy versus double therapy versus triple therapy in the treatment of diabetic macular edema

ABSTRACT

To compare the efficacy of macular laser photocoagulation [MPC] alone or MPC with intravitreal Bevacizumab or MPC with both intravitreal bevacizumab and intravitreal triamcinolone as primary treatment of Diabetic macular edema [DME]. A randomized clinical trial. Fifty eyes of 30 patients with clinically significant DME and no previous treatment were enrolled. The eyes were randomly assigned to one of three treatments groups. In Group-1, 20 eyes underwent focal or modified grid laser, In group-2, 15 eyes received 1.25 mg / 0.05ml of intravitreal bevacizumab [IVB] followed by MPC while in group-3, 15 eyes received 1.25 mg / 0.05ml of IVB and 2 mg / 0.05ml of intravitreal triamcinolone [IVT] followed by MPC. At 12 weeks after treatment, average improvement of visual acuity in group-1 was 1.0 line, in group-2 was 1.5 lines and in group-3 was 2.0 lines. Average central macular thickness reduction was significantly more [p=0.001] in group-3 [354 +/- 110 [micro]m] than in group- 1 [1 67 +/- 57 [micro]m] and group- 2 [278 +/- 76 [micro]m]. Up to 12 weeks triple therapy group showed better visual outcome than the other two groups where as the average reduction in central macular thickness was also more in triple therapy group. Further clinical trials with longer follow-up are required to evaluate the long-term visual outcomes and complication profiles after this treatment