Comparison of Intravitreal Bevacizumab and Intravitreal Diclofenac in Treatment of Diabetic Macular Edema in a 6 Month Follow-up

Hooshang Faghihi, Hanif Yahyapour, Razyieh Mahmoudzadeh, Shahin Faghihi

Abstract


This study was designed to compare the effect of intravitreal Diclofenac which is a member of Non-steroidal anti-inflammatory drugs (NSAIDs) with Bevacizumab, the well-known anti-vascular endothelial growth factor (VEGF) in treatment of diabetic macular edema (DME). Diclofenac was chosen in this study because it has both features of NSAIDs and corticosteroids by inhibiting Cyclooxygenase (COX) pathway and lipoxygenase pathway respectively. In this non-randomized comparative interventional case series, 64 eyes from 32 patients with bilateral naive DME were selected and every eye was randomly assigned to intravitreal injection of Bevacizumab (IVB) or diclofenac (IVD). After exclusion of some patients because of short term follow up or less than 2 intravitreal injections, finally 26 eyes from 52 patients were analyzed. 26 eyes received intravitreal injection of diclofenac (500 µg/0.1 ml), and 26 eyes received intravitreal injection of bevacizumab (1.25 mg). After 6 month follow up the results indicated that both group significantly improved visual acuity in LogMAR, which was /0±50/013 in IVB and 12/0±52/0 LogMAR in IVD group at base line and reduced to 0/2±0/1 and 07/0±29/0 respectively after 6 month follow up. Central macular thickness (CMT) and macular volume were measured based on spectral-domain optical coherence tomography (OCT) at month 1, 3 and 6. Both groups had significant reduction in CMT and macular volume from baseline but there was no significant difference between IVB and IVD groups. Interestingly IVD decreased intraocular pressure (IOP) which is a desirable effect but IVB had no significant effect on IOP. There was no serious complication due to injections in this study. This study may shed light on the long term effects of NSAIDs and may support this idea that inflammation suppression by the aid of NSAIDs may have the same results of anti-VEGF administration.




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