Evaluation of intravitreal bevacizumab as monotherapy and in combination with macular grid laser photocoagulation in diffuse diabetic macular edema.

BACKGROUND AND OBJECTIVE: The objective of the study was to compare the efficacy of intravitreal bevacizumab (IVB) as monotherapy versus combination with modified macular grid (MMG) laser photocoagulation in the primary treatment of diffuse diabetic macular edema (DDME). MATERIALS AND METHODS: A prospective randomized trial was carried out in sixty eyes with DDME after Institutional Ethical clearance. Group A received three doses of IVB at a 1-month interval. Group B received MMG in addition to IVB. Complete examination including best-corrected visual acuity (BCVA) (Snellen's), central macular thickness (CMT) using spectral domain-optical coherence tomography was carried out at 0, 1, 4, 8, 12, and 24 weeks. RESULTS: mean CMT at baseline, 12 and 24 weeks in Group A was 401 (±76), 280 (±49), and 307 (±46) and in Group B, 405 (±73), 237 (±33), and 242 (±45), respectively. Group B had significantly greater reductions (P < 0.001) from 12 weeks onward. BCVA and contrast sensitivity showed improvements with no significant difference. CONCLUSION: Combined therapy has more advantage in primary DDME by reducing CMT on longer follow-up.

Efficacy of Phacotrabeculectomy Alone versus Phacotrabeculectomy Augmented with Autologous Anterior Capsule Implantation Beneath the Sclera Flap.

PURPOSE: To evaluate the efficacy of autologous anterior lens capsule (ALC) in phacotrabeculectomy. MATERIAL AND METHODS: In this prospective, randomized case control study, after obtaining institutional ethical clearance and informed consent, 88 eyes posted for phacotrabeculectomy were divided into ALC and non-ALC groups. Combined phacoemulsification, with posterior chamber intraocular lens implantation and trabeculectomy, was performed in both groups. Anterior lens capsule transplantation was done in the first group beneath the sclera flap. Follow-up of three months was carried out and the morphology of bleb, intraocular pressure (IOP), requirement for additional medications, and complications were compared between the two groups. RESULT: Statistical difference favoring the ALC group was seen in IOP reduction (p < 0.05) at each follow-up, qualified success rate and failure rate at the three-month follow-up (p = 0.006), but no difference in bleb morphology was seen. CONCLUSION: ALC implantation is beneficial in maintaining filtration in a combined surgery with minimal complications.