Online ISSN: 2515-8260

Keywords : Diabetic macular edema

Comparative Evaluation of Efficacy of Intravitreal Bevacizumab (1.25mg) and Laser Monotherapy in Treatment of Diabetic Macular Edema – A Short Term Hospital Based Study in North India

Dr. Brijesh Singla, Dr. Karamjit Singh,Dr. Prempal Kaur, Dr. Rajesh Kumar, Dr. Amanpreet Kaur, Dr. Bhuvnesh Singla

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 2, Pages 2062-2068

To compare the treatment efficacy of intravitreal bevacizumab (1.25 mg) and laser monotherapy in diabetic macular edema in patients of type 2 diabetes mellitus.
Settings and Design: Randomised, non-blinded prospective interventional study conducted in a tertiary care hospital on 66 eyes of type 2 diabetes patients.
Methods and Material: After obtaining informed consent, patients diagnosed with non-proliferative diabetic retinopathy (NPDR) and DME defined as clinically significant macular edema (CSME) were recruited in the study. The selected patients were randomized into two groups – group A (n=33) - macular laser photocoagulation and group B (n=33) - three monthly intravitreal bevacizumab injections (1.25 mg). At 3 months follow up, comparison of change in central macular thickness (CMT), macular volume (MV) and best corrected visual acuity (BCVA) was done.
Statistical analysis used: SPSS 21, IBM, USA, Pearson’s chi-squared test and two sample t-test.
Results: CSME resolved in 11 (33.33%) patients in laser group and 21 (63.64%) patients in the intravitreal bevacizumab group. Mean CMT decreased from 496.03µm to 339.24µm in laser group and from 516.48µm to 283.27µm in the bevacizumab group (p<0.05). Bevacizumab group showed greater reduction in mean MV laser group (p<0.05). Mean BCVA (logMAR) improved from 0.83 to 0.49 in the bevacizumab group while in the laser group, marginal improvement was seen from 0.81 to 0.76 (p<0.001).
Conclusions: Intravitreal bevacizumab is superior to macular laser photocoagulation in structural and functional improvement in NPDR with CSME.

Outcome of eyes with diabetic macular edema with laser treatment

Dr Saudhan Desai, Dr Suhani Nayak, Dr H K Bhavsar, Dr Pravinchandra Kanjibhai Solanki

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 1556-1562

Background: Diabetic macular edema (DME) is a leading cause of visual impairment and its treatment is a public health challenge. Antiangiogenic agents are the gold standard treatment, but they are not ideal, and subthreshold laser (SL) is a viable and promising treatment in certain cases. The purpose of this study was to evaluate its usefulness in a real-world environment.
Methods: A retrospective case series of 54 eyes of 32DME patients admitted to the center treated with SL monotherapy. Treatment was performed using the EasyRet® photocoagulator with the following parameters in one session: 5% duty cycle, 200 ms pulse duration, 160 µm spot size, and barely visible.Output at 50% of threshold. A high-density pattern was then applied across the edematous region using multi-spot mode. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and approximately 3 months after treatment.
Results: 54 eyes of 32 patients were included (38% female, mean age 63.8 years). The mean time from treatment date to follow-up visit was 12±6 weeks. BCVA (Snellen transformed to logMAR) was 0.59±0.32 and 0.43±0.25 at baseline and follow-up, respectively (p=0.002). 32% had previously undergone pan-retinal photocoagulation (p = 0.011). The average laser power was 555 ± 150 mW and the number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) were observed in 96 and 41% of eyes at baseline and improved in 35 and 74% of eyes, respectively, after treatment. Quantitative analysis of changes in central macular thickness (CMT) was performed in a subset of 23 eyes, of which 43% showed a greater than 10% reduction in CMT after treatment.
Conclusions: Subthreshold laser therapy is known to have RPE function as a major target that normalizes heat shock protein activation and cytokine expression. In the present study, cases of DME associated with SRF showed excellent physiological responses, whereas laser monotherapy did not respond to a reduction of intraretinal edema. BCVA and macular thickness showed a mild response, suggesting the need for combined treatment in most patients. may be a viable treatment option.

Efficiency of Fenofibrate in Facilitating the Reduction of Central Macular Thickness in Diabetic Macular Edema

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3160-3164

Background: Diabetic macular edema (DME) has been reported at rates of 10% and occurs more frequently in type 2 diabetes mellitus. The present study was conducted to assess the efficiency of fenofibrate in facilitating the reduction of central macular thickness in diabetic macular edema.
Materials & Methods: 60 patients with type 2 diabetes having treatment naïve, center‑involving DME of both genders were divided into 2 groups.  Group I had DME only in one eye and group II had DME in both eyes. Group I were given oral fenofibrate 160 mg/day for 6 months as a single evening dose. Central macular thickness in both groups was compared.
Results: The mean FBS was 137.6 mg/dl in group I and 158.2 mg/dl in group II, PPBS was 210.4 mg/dl and 238.6 mg/dl, blood urea (mg/dl) was 29.3 in group I and 31.5 in group II and serum creatinine (mg/dl) was 0.92 and 0.99 in group I and in group II respectively. CMT in group I and group II at baseline was 432.6 and 402.1, at 2 months was 360.2 and 358.1, at 4 months was 327.5 and 331.4 and at 6 months was 294.3 and 317.6 in group I and in group II respectively. The difference was non- significant (P>0.05).
Conclusion: Fenofibrate facilitate reduction of central macular thickness in patients with diabetic macular edema

Automatic detection of exudates for grading of macular edema in retinal fundus images

Dr. J.Benadict Raja; B. Sakthi Karthi Durai

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 4, Pages 1960-1968

Macular edema is one of the retinal variations from the norm which influence the vision of the individual and prompts visual deficiency torn up pretty bad. In this paper a completely robotized strategy is proposed for the early discovery of macular edema in retinal fundus pictures. At first, the anatomic structures of retinal picture, for example, vessel, optic disc and fovea are identified. At that point the exudates which are available in the fovea part are distinguished for reviewing macular edema. The proposed technique was assessed on the two openly accessible DRIVE and STARE databases.