Intravitreal bevacizumab and laser therapy in the management of diabetic macular edema / Шинэ санаа Шинэ нээлт

ABSTRACT

Diabetic retinopathy (DR) is an important cause of vision loss around the world, being the leading cause in the population between 40 and 59 years old. Among patients with DR, diabetic macular edema (DME) is the most frequent cause of vision impairment and represents a significantpublic health issue. The Early Treatment Diabetic Retinopathy Study (ETDRS) showed the benefit of focal/grid laser for the management of DME, reducing the risk of moderate visual loss by approximately 50%, and since then,macular photocoagulation (MPC) has been the gold standard treatment. Vascular endothelial growth factor (VEGF) is an important mediator of blood-retinalbarrier breakdown, which leads to fluid leakage and the development of macular edema. The efficacy and safety of intravitreal anti-VEGF as therapy for DME have recently been proved by various clinical trials providing significantly positive visual and anatomical results. Regarding clinical practice, those outcomes have placed intravitreal injection of anti-VEGF as an optionthat must be considered for the treatment of DME. The aim of this study to evaluate intravitreal bevacizumab and modified Early Treatment Diabetic Retinopathy Study (ETDRS) macular laser therapy (MLT) in patients with clinically significant macular edema (CSME). Methods: In a1-year, single-center, randomized controlled trial, 70 patients with center-involving CSME were randomized to receive either bevacizumab or MLT. Result: The baseline mean ETDRS BCVA was 58.3±8.6 (range 38–71) in the bevacizumab group and 56.6±7.3 (range 37–69) in the laser group. The mean ETDRS BCVA at one year was 63.2±12.5 (range 41–80) in the bevacizumab group and53.0±8.3 (range 35–74) in the laser group (p=0.0004). At one year, central macular thickness decreased from 405±121 μm (range 275–715 μm) at baseline to 247±141 μm (range 178±541 μm) in the bevacizumab group and in the laser group from 392±137 μm (range 284–741 μm) to 318±129 μm (range 165–615 μm) (p=0.05). Conclusioni The study provides evidence to support the use of bevacizumab in patients with center involving CSME without advanced macular ischemia.