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      Short term effect of intravitreal bevacizumab for diabetic macular edema associated with epiretinal membrane

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          Abstract

          Purpose: To evaluate the effect of intravitreal bevacizumab (IVB) injection on central macular thickness (CMT) in patients with diabetic macular edema (DME) associated with epiretinal membrane (ERM) and compare the results to those with DME without ERM.

          Methods: 54 eyes of 54 patients with DME were included in this prospective comparative case series. Twenty-eight patients had ERM. All patients received 2.5 mg/ 0.1 ml IVB. The primary outcome measure was the change in central macular thickness (CMT) and the secondary outcome measure was the change in best corrected visual acuity (BCVA), one month after the IVB injection.

          Results: All the patients completed 1-month follow-up. One month after the IVB injection, there was no statistically significant reduction in terms of CMT for the ERM group (22.64 ± 70.1 μm; P = 0.099), unlike eyes with DME alone (60.34 ± 88.5 µm; P = 0.002). Patients with ERM had a -0.09 ± 0.14 log MAR improvement in their BCVA (P =0.001) vs. 0.03 ± Log MAR change in the patients who did not have ERM (P = 0.37).

          Conclusion: In this study, intravitreal bevacizumab resulted in improvement in BCVA in patients who had DME associated with ERM. However, in patients who only had DME, despite a reduction in CMT, no improvement in BCVA occurred. Future randomized clinical trials are warranted to precisely assess the effect of bevacizumab on the ERM.

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          Most cited references21

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          Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.

          (1985)
          Data from the Early Treatment Diabetic Retinopathy Study (ETDRS) show that focal photocoagulation of "clinically significant" diabetic macular edema substantially reduces the risk of visual loss. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. In this randomized clinical trial, which was supported by the National Eye Institute, 754 eyes that had macular edema and mild to moderate diabetic retinopathy were randomly assigned to focal argon laser photocoagulation, while 1,490 such eyes were randomly assigned to deferral of photocoagulation. The beneficial effects of treatment demonstrated in this trial suggest that all eyes with clinically significant diabetic macular edema should be considered for focal photocoagulation. Clinically significant macular edema is defined as retinal thickening that involves or threatens the center of the macula (even if visual acuity is not yet reduced) and is assessed by stereo contact lens biomicroscopy or stereo photography. Follow-up of all ETDRS patients continues without other modifications in the study protocol.
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            Prevalence of and risk factors for diabetic macular edema in the United States.

            Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically.
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              Diabetic macular oedema.

              Diabetic macular oedema, characterised by exudative fluid accumulation in the macula, is the most common form of sight-threatening retinopathy in people with diabetes. It affects one in 15 people with diabetes resulting in more than 20 million cases worldwide. Few epidemiological studies have been done to specifically investigate risk factors for diabetic macular oedema, although poor glycaemic and blood pressure control are associated with the presence and development of the disorder. The pathophysiological processes begin with chronic hyperglycaemia, and interplay between vascular endothelial growth factor (VEGF) and inflammatory mediators. Non-invasive imaging using optical coherence tomography has allowed clinicians to detect mild levels of diabetic macular oedema in order to monitor progress and guide treatment. Although focal or grid laser photocoagulation was the traditional mode of treatment, intraocular pharmacotherapy with anti-VEGF agents is now the standard of care. However, these therapies are expensive and resource intensive. Emerging therapeutic strategies include improving efficacy and duration of VEGF suppression, targeting alternative pathways such as inflammation, the kallikrein-kinin system, the angiopoietin-Tie2 system, and neurodegeneration, and using subthreshold and targeted laser therapy. Ongoing research should lead to improvements in screening, diagnosis, and management of diabetic macular oedema.
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                Author and article information

                Journal
                Rom J Ophthalmol
                Rom J Ophthalmol
                RomJOphthalmol
                Romanian Journal of Ophthalmology
                Romanian Society of Ophthalmology (Romania )
                2457-4325
                2501-2533
                Jul-Sep 2018
                : 62
                : 3
                : 212-216
                Affiliations
                [* ]Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence to: Khalil Ghasemi Falavarjani, MD, Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niaiesh St., Tehran, Iran, PO Box: 1445613131, Tehran, Iran, Phone: +9812 172 5850, +9821 665 091 62, Fax: +9821 665 091 62, E-mail: drghasemi@yahoo.com
                Article
                RomJOphthalmol-62-212
                6256081
                958796d5-5f60-4bdd-9f2c-85471197db82
                ©Romanian Society of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 August 2018
                Categories
                General Articles

                diabetic macular edema,epiretinal membrane,bevacizumab

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