Early effect of simultaneous intravitreal dexamethasone and bevacizumab combination treatment in patients with persistent diabetic macular edema

Purpose. - To report the early effect of simultaneous intravitreal dexamethasone and bevacizumab combination treatment in patients with persistent diabetic macular edema (DME). Methods. - In this single-center prospective non-randomized study, 65 eyes of 59 patients with persistent DME were included. In the combined group (Group 1), we treated 35 eyes of 29 persistent DME patients with a simultaneous combination of intravitreal dexamethasone and bevacizumab, and in the control group (Group 2), we treated 30 eyes of 30 patients with intravitreal bevacizumab. Changes in Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT) and Intraocular Pressure (IOP) from the initial visit to each subsequent follow-up visit (1st, 2nd and 3rd months) were recorded. Results. - In Group 1, the mean baseline Early Treatment Diabetic Retinopathy (ETDRS) BCVA letter score was 44.1 +/- 19.3 (range 2051), improving significantly to 58.8 +/- 18.2 (range 4273) in the first month (P < 0.05), 57 +/- 19.2 (range 4072) in the second month (P < 0.05) and 55.4 +/- 18.4 (range 3471) in the third month (P < 0.05). In Group 2, the mean pre-injection BCVA ETDRS letter score was 43.3 +/- 18.8 (range 2056) and did not improve significantly; the letter score was 44.3 +/- 18.1 (range 2049) in the third month. In Group 1, the mean BCVA change from baseline to the 3rd month was 11.3 ETDRS letters. In Group 2, the mean BCVA change from baseline to the 3rd month was 1 ETDRS letter. In Group 1, the mean reduction in CMT from baseline was -142.25 mu m. In Group 2, the mean reduction in CMT from baseline was -17.30 mu m. In Group 1 at the third month, 12 (34.2%) eyes with a CMT > 300 mu m needed an additional injection. No serious ocular or systemic side effects occurred in any patient. Conclusion. - Simultaneous intravitreal dexamethasone and bevacizumab combination treatment is effective and can be used safely in persistent DME. (C) 2021 Elsevier Masson SAS. All rights reserved.