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Background: Intravitreal injection of anti-vascular endothelial growth factor agents is the main therapeutic option in treatment of diabetic macular edema (DME). Some eyes with DME persistent despite frequent injections. Adjuvant therapies that further reduce edema may improve visual outcome. Aim of The Work:To assess influence of topical dorzolamide-timolol with intravitreal ranibizumab injection (IVR) on anatomical and functional outcomes in DME. Patients and Methods: This prospective cohort study included thirty patients (30 eyes) having type 2 DM, aged 45-60 years, all eyes have NPDR with DME. They were divided into 2 groups according to treatment protocol: Group 1: 15 patients (15 eyes) received IVR (3 monthly injection of Lucentis® 0.5 mg/0.05 ml) and adjuvant topical dorzolamide-timolol (Xolamol™ eye drops twice daily). Group 2: 15 patients (15 eyes) received IVR only. Results: Mean BCVA changes were significant in both groups, it changed from 0.93 ± 0.23 logMAR at baseline to 0.73 ± 0.27 (P < 0.001) in group 1 & from 0.93 ± 0.3 logMAR to 0.8 ± 0.33 (P = 0.001) in group 2. changes in mean CMT were significant in both groups, it changed from 568.67 ± 145.76 at baseline to 384 ± 110.63 (P ˂ 0.001) in group 1 & from 513.4 ± 114.54 at baseline to 387.87 ± 119.52 (P ˂ 0.001) in group 2, at 4th month. Comparing group 1 and group 2 from baseline to the last visit, mean changes in BCVA was 0.2 vs 0.13, mean changes in CMT was -184.67μm vs -125.53μm but the differences between the 2 groups were not statistically significant. Conclusion: Adjuvant topical dorzolamide -timolol with IVR had additive effects, but not a statistically significant, on IVR in the treatment of DME over a 4-month-course.

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