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Year : 2018  |  Volume : 111  |  Issue : 4  |  Page : 144-152

The efficacy of adjunct therapy by intravitreal aflibercept and laser versus triamcinolone and laser in the treatment of diabetic macular edema: a 6-month study

Department of Ophthalmology, Faculty of Medicine, Ain shams University, Ramses Street, Abbasia Square, Cairo, Egypt

Correspondence Address:
Ashraf H Soliman
Department of Ophthalmology, Faculty of Medicine, Ain shams University, Ramses Street, Abbasia Square, Cairo 11517
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ejos.ejos_59_18

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Aim The aim was to compare visual and central macular thickness (CMT) improvement and complications of adjunct intravitreal aflibercept (IAI) (2 mg) 0.05 ml followed by argon laser photocoagulation with adjunct intravitreal triamcinolone 4 mg/0.1 ml followed by argon laser photocoagulation in treating diabetic macular edema. Patients and methods A total of 30 eyes of 26 patients with type II diabetes having visual loss owing to clinically significant macular oedema (CSME) and confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were included. Patients were randomly assigned into two groups: group 1 was treated by IAI (0.05 ml) 2 mg/4 weeks (2q4) for a total of five doses, and group 2 by intravitreal triamcinolone acetonide 4 mg/0.1 ml. Best corrected visual acuity (BCVA) and clinical examination were done monthly. OCT was done at 2, 4, and 5 months. At 5 months, and CMT allowing, FFA was done and laser photocoagulation was performed on distinct leakers. OCT and FFA were done at 6 months, and results were compared between the two groups. Results At 6 months, there was a statistically significant improvement (P<0.05) of CMT in the IAI group compared with IVTA group (P=0.04 and 0.469, respectively). The IVTA group showed an ill-sustained effect, where four cases required reinjection. BCVA for the IAI group continued to improve throughout the study period, with statistically significant values until the end point (P=0.033). IVTA group showed statistically significant improvement in BCVA at the 2-month and 4-month visits, but insignificant changes thereafter (P=0.76 at 6 months). These changes were similar to CMT. Overall, five (33%) eyes in the IVTA group had an increase in intraocular pressure (IOP), with the highest at 12th week, and were treated by topical timolol 0.5% bid. Moreover, one patient had a visually significant posterior subcapsular cataract, and phacoemulsification with intraocular lens (IOL) implantation was performed after the study. One case in each group developed self-limited vitreous hemorrhage, which resolved spontaneously. Conclusion IAI/laser provides superior and more sustained anatomical CMT and BCVA results with fewer complications compared with the intravitreal triamcinolone/laser.

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