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Minerva Oftalmologica 2019 September-December;61(3-4):71-80

DOI: 10.23736/S0026-4903.19.01838-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: Italian

Medical and surgical treatment of diabetic macular edema: OCT results at 6 months

Santolo PEZZELLA , Ada ORRICO, Franco CORONELLA, Paola GIACOIA

Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy



The purpose of this work is to examine the efficacy of intravitreal anti-VEGF and steroid drugs in the treatment of macular edema in diabetic patients with diabetic retinopathy. Our study is based on the observation of changes in retinal thickness and the presence of macular edema by means of OCT-graphic surveys with Heidelberg Spectralis OCT, of ten patients suffering from diabetic retinopathy, two treated with a slow-release de-metabolic implant, three treated with ranibizumab, five treated with aflibercept. In the two patients treated with dexamethasone implant there is a marked reduction of the edema and consequently of the retinal thickness in the period in which the insert actively released the drug, except in both cases to observe a re-ignition of the inflammatory focus and reappearance of cystoid macular edema. In the three patients treated with ranibizumab a significant decrease in edema is observed between the first and third injections carried out monthly with almost total resorption of macular edema; interruption of therapy is observed with a new increase in edema and the appearance of new intraretinal edematous cavities. In the five patients treated with aflibercept there is a clear decrease in retinal thickness and macular edema during the first phase of treatment with almost physiological values and a lower occurrence of relapses when the monthly treatment is suspended. In all the observed cases the therapy with intravitreal injections has obtained discrete results in terms of decreased retinal thickness and edema reabsorption but the bad control of the glycemic level also in the therapy phase, causes instability of the therapy itself and of the failure success at the end of it. Therapy with intravitreal injections of aflibercept or ranibizumab is very effective and free from serious ocular complications. Cortisone implant therapy, also effective but with greater ocular risks. In any case, these therapies are subject to poor results if not accompanied by a good metabolic compensation.


KEY WORDS: Optical coherence tomography; Macular edema; Intravitreal injections; Diabetic retinopathy

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