Intravitreal Diclofenac plus Bevacizumab versus Bevacizumab alone in treatment-naive diabetic macular edema: a randomized double-blind clinical trial

Ghanbari, Heshmatollah; Kianersi, Farzan; Sonbolestan, Seyed Ali; Abtahi, Mohammad‐Ali; Akbari, Mojtaba; Abtahi, Zahra-Alsadat; Abtahi, Seyed‐Hossein

doi:10.1007/s10792-016-0335-z

Cited by 12 publications

(11 citation statements)

References 25 publications

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“…Multiple studies have also evaluated the use of intravitreal NSAIDs in the form of diclofenac (Troge Medical GMBH, Hamburg, Germany) compared to and in combination with IVB. Overall, these studies have shown visual and macular thickness benefits to such treatment which, in some cases, was superior to IVB monotherapy [ 154 , 155 , 156 ]. These studies were all performed in treatment naïve eyes, but the evidence of the benefit of NSAID therapy as a possible adjuvant treatment with anti-VEGF injections appears consistent.…”

Section: Diabetic Retinopathy and Diabetic Macular Edemamentioning

confidence: 99%

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Wallsh

Gallemore

2021

Cells

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Anti-vascular endothelial growth factor (anti-VEGF) therapy currently plays a central role in the treatment of numerous retinal diseases, most notably exudative age-related macular degeneration (eAMD), diabetic retinopathy and retinal vein occlusions. While offering significant functional and anatomic benefits in most patients, there exists a subset of 15–40% of eyes that fail to respond or only partially respond. For these cases, various treatment options have been explored with a range of outcomes. These options include steroid injections, laser treatment (both thermal therapy for retinal vascular diseases and photodynamic therapy for eAMD), abbreviated anti-VEGF treatment intervals, switching anti-VEGF agents and topical medications. In this article, we review the effectiveness of these treatment options along with a discussion of the current research into future directions for anti-VEGF-resistant eyes.

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Section: Diabetic Retinopathy and Diabetic Macular Edemamentioning

confidence: 99%

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Wallsh

Gallemore

2021

Cells

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“…However, this outcome does not support the previous research where the combination of bevacizumab intravitreal injection and diclofenac intravitreal injection reduced CMT more than bevacizumab intravitreal injection only in patient with naïve diabetic macular edema. (8) A possible explanation for this might be because the NSAIDs (9) The differences between this study and the study conducted by Warren are the naïve/refractory status of the diabetic macular edema and the NSAID used of this study were different. Compared with diclofenac, amfenac, and ketorolac, bromfenac is reported to be a 3 to 18 times more potent inhibitor of COX-2.…”

Section: Discussionmentioning

confidence: 83%

Central Macular Thickness After Combined Therapy of Bevacizumab Intravitreal Injection and Topical Diclofenac Compared With Bevacizumab Intravitreal Injection Alone in Diabetic Macular Edema

Sandra¹,

Shabrina²,

Widayanti³

et al. 2021

IJRetina

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Introduction: To evaluate whether the combination of diclofenac eye drops and bevacizumab intravitreal injection would provide additional benefits over bevacizumab alone in the treatment of naïve diabetic macular edema (DME). Methods: A total of 43 patients were enrolled consecutively and randomized into two groups to receive combination treatment with intravitreal bevacizumab and topical diclofenac (group 1) or bevacizumab alone (group 2). Group 1 patients received single bevacizumab intravitreal injection and got self-administered diclofenac eye drop four times daily for one month. Group 2 patients received single bevacizumab intravitreal injection alone. Outcome data were obtained from patient visits at baseline and at 1 month after bevacizumab intravitreal injection. All patients underwent measurement of best corrected visual acuity (BCVA), a complete eye examination, and measurement of central macular thickness (CMT). Result: The mean reduction in CMT in the combination group was 130.42±32.57 µm (p<0.01), while in the bevacizumab alone group the reduction was 141.38±45.27 µm (p<0.01), there is no significant difference between the two groups (p=0.866). The mean improvement of BCVA was 0.32±0.10 log Mar in the combination group and 0.26±0.12 in group 2, there is no significant difference between the two groups (p=0.691). There was no adverse ocular event in the two groups. Conclusion: In patients with naïve DME, adding diclofenac eye drop as adjuvant of bevacizumab intravitreal injection are less likely to have a meaningful effect on reducing the central macular thickness. Keywords: Diabetic macular edema, NSAID, diclofenac, anti-VEGF, bevacizumab, central macular thickness

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“…This study found that the combination therapy reduced CST more than bevacizumab alone but not visual acuity. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

Intravitreal anti-vascular endothelial growth factor with and without topical non-steroidal anti-inflammatory in centre-involving diabetic macular edema

Mohan

Chawla²,

Surya

et al. 2021

Indian J Ophthalmol

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Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the mainstay in the management of center-involving diabetic macular edema (CI-DME). Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to treat CI-DME as well. Whether there is any benefit of using both together has not been explored. The aim of this study was to compare visual acuity and OCT outcomes in patients with CI-DME who receive intravitreal anti-VEGF with and without topical NSAIDs in CI-DME. Methods: This was A retrospective observational study in two centers in India. The study compared visual and OCT parameters of patients with CI-DME treated with intravitreal anti-VEGF monotherapy (group 1, N = 100) versus intravitreal anti-VEGF therapy with topical NSAIDs (group 2, N = 50) over 1-year follow-up. Continuous and categorical parameters were compared using parametric and nonparametric tests, respectively. Results: Over the 1-year follow-up, group 2 received more mean number of intravitreal injections (group 1: 2.26 ± 1.71 vs. group 2: 3.74 ± 2.42; P < 0.0001). There were no differences between the groups in visual acuity and OCT thickness at 1-year follow-up. Conclusion: Combination therapy of topical NSAIDs with intravitreal anti-VEGF did not show any beneficial effects in terms of visual outcomes, reduction in central subfoveal thickness, or reduction in the mean number of injections in our study.

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Intravitreal Diclofenac plus Bevacizumab versus Bevacizumab alone in treatment-naive diabetic macular edema: a randomized double-blind clinical trial

Cited by 12 publications

References 25 publications

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Central Macular Thickness After Combined Therapy of Bevacizumab Intravitreal Injection and Topical Diclofenac Compared With Bevacizumab Intravitreal Injection Alone in Diabetic Macular Edema

Intravitreal anti-vascular endothelial growth factor with and without topical non-steroidal anti-inflammatory in centre-involving diabetic macular edema

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