I pazienti affetti da edema maculare diabetico refrattario trattati con questa triplice terapia venivano confrontati con un gruppo storico sottoposto alla sola tradizionale terapia laser. Si è ottenuto un buon risultato anatomico con importante riduzione dell’edema e dello spessore maculare, ma non si è assistito ad un proporzionale incremento dell’acuità visiva.

Retina the journal of retinal and vitreous diseasesCombined high-dose sub-tenon triamcinolone, intravitreal bevacizumab, and laser photocoagulation for refractory diabetic macular edema: a pilot study

Chan, Carmen K. M. MRCP, FRCSEd(Ophth)*,†; Lai, Timothy Y. Y. MD, FRCSEd(Ophth)*,†; Mohamed, Shaheeda MPH, FRCSEd(Ophth)*,†; Lee, Vincent Y. W. FRCS, MSc*,‡; Liu, David T. L. FRCS*,‡; Li, Chi-Lai MRCS(Edin)*,‡; Lam, Dennis S. C. MD, FRCOphth*,†

Retina
April 2012 – Volume 32 – Issue 4 – p 672–678



Method: Twenty-nine eyes of 29 patients who received triple therapy were monitored for central foveal thickness, best-corrected visual acuity (BCVA), and side effects over a 1-year period. Their results were compared with a focal/grid laser historical control group of 18 eyes (18 patients).

Results: In the triple therapy group, mean central foveal thickness significantly reduced from baseline value of 441 μm to 298 μm at Month 12 (P < 0.001), but there was no significant change of BCVA. In the control group, there were no sustained significant changes of central foveal thickness or BCVA. A subgroup analysis of 7 eyes in the triple therapy group with baseline BCVA of ≤20/100 showed significant BCVA improvements from 4 weeks to 9 months. The maximum improvement was achieved at 6 months, when the mean BCVA improved by 9.5 Early Treatment Diabetic Retinopathy Study letters from baseline. Intraocular pressure rise (31.0%), partial ptosis (17.2%), and significant cataractogenesis (8.7%) were encountered in the triple therapy group but not in the control group.

Conclusion: Sustained reduction of central foveal thickness was achieved with triple therapy over the 1-year study period. Significant visual improvement was seen only in patients with worse baseline BCVA, but not in the triple therapy group as a whole. Significant side effects of intraocular pressure rise, ptosis, and cataractogenesis were encountered in the triple therapy group.