Intravitreal Bevacizumab Alone Versus Combined Bevacizumab and Macular Grid Laser Photocoagulation in Diffuse Diabetic Macular Oedema

Abstract

Introduction: Diabetes Mellitus (DM) is a common disease with multiple systemic complications. Diabetic macular oedema is the main threat to vision in patients with diabetic retinopathy, which results from the increased permeability of the inner and outer blood-retinal barrier. Macular argon laser photocoagulation was the only treatment of diabetic macular oedema in the past. Now-a-days, both intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and macular grid laser photocoagulation are used in the management of diffuse and focal Diabetic Macular Oedema (DME). Aim: To assess the changes in both visual acuity and Central Macular Thickness (CMT) in patients with DME after intravitreal injection of bevacizumab only or in combination with macular grid laser treatment. Materials and Methods: A prospective longitudinal cohort study included 89 eyes of 52 patients with DME, who were categorised into two interventional groups. The first group received only intravitreal bevacizumab for the first three months, then Pro Re Nata (PRN), while the second group received intravitreal bevacizumab, similar to the first group, in addition to macular grid laser treatment two weeks after the initial injection. Participants were followed-up at 12 months, and the visual acuity, CMT, and the total number of injections were documented. Patients were followed-up but data was gathered on baseline and at the 12th month were compared. Results: In comparison to the initial presentation, a significant decrease in CMT was noticed in both groups (163.47±83.60 µm vs. 126.45±52.45 µm, respectively). Moreover, a significant improvement in visual acuity of both groups (p<0.023 and p<0.016, respectively) and significantly fewer injections being required in the second group were noticed. Conclusion: Combining intravitreal bevacizumab with macular grid laser treatment can lead to stabilisation and improvement of visual acuity with a smaller number of injections which was statistically significant.

Keywords

• argon laser
• central macular thickness
• diabetes mellitus
• diabetic retinopathy
• visual acuity