Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome

Abstract

Purpose: To compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema.

Methods: Fifty eyes with persistent DME were randomly allocated to intravitreal injection of 500 µg/0.1 ml of diclofenac (N = 20) or 1.25 mg/0.05 mL of bevacizumab (N = 20) or to non-treatment (10 eyes). Preoperative and postoperative visual acuity, central, paracentral macular thickness and intraocular pressure (IOP) were recorded and compared between the three groups up to 4 weeks.

Results: Diclofenac and bevacizumab groups showed statistically significant reduction in central and paracentral macular thickness (diclofenac: p = 0.006, 0.02 and bevacizumab: p = 0.02, 0.01), without statistically significant difference between the two groups. The two groups showed no statistically significant difference in mean visual acuity or mean line improvement. Mean visual acuity improvement didn't reach statistical significance in either group. Diclofenac group showed statistically significant reduced IOP (P = 0.02). Control eyes did not show any change in mean visual acuity, macular thickness or IOP.

Conclusion: In persistent DME, diclofenac has a structural effect comparable to bevacizumab on central macular thickness. However, significant functional gain may not be accomplished by single injection. Unlike naïve DME, persistent cases may be confounded by systemic and local factors necessitating repeated injection of diclofenac.

Keywords: Bevacizumab; Diabetic macular edema; Diclofenac; Intravitreal injection.

Fig. 1

Intravitreal diclofenac. (A) Preoperative thickness map showing foveal and parafoveal thickening in the nasal, temporal and inferior quadrants. (B) Preoperative b-scan showing diffuse macular edema and sensory retinal detachment. (C) Postoperative thickness map after one month showing a significant reduction of foveal and parafoveal thickness. (D) Postoperative b-scan reveals a corresponding reduction of macular edema.

Fig. 2

Intravitreal bevacizumab. (A) Preoperative thickness map showing foveal and parafoveal thickening in all quadrants. (B) Preoperative b-scan showing diffuse macular edema with cystoids thickening of the fovea. (C) Postoperative thickness map after one month showing mild reduction of foveal thickness. (D) Postoperative b-scan reveals a corresponding reduction of foveal edema.

Fig. 3

Control group. (A) Thickness map showing foveal and parafoveal thickening in the nasal and superior quadrants. (B) b-scan showing diffuse macular edema in foveal and nasal parafoveal region. (C) Thickness map after one month showing persistent foveal and parafoveal thickening. (D) Postoperative b-scan after one month reveals persistence of macular edema.