Intravitreal Ranibizumab Versus Its Combination With Dexamethasone in The Treatment of Diabetic Macular Edema

This prospective randomized study measures the changes in central macular thickness, best corrected visual acuity and IOP in diabetic macular edema before and after the intravitreal injection of ranibizumab and dexamethasone, compared to ranibizumab alone, the current gold standard of care for diabetic macular edema.

Study participants were randomized into 2 groups: the first group received 3 Intravitreal injections of ranibizumab alone 1 month apart. While the second group received 1 Intravitreal injection of a combination of ranibizumab and 0.4 mg in 0.1 ml dexamethasone followed by 2 Intravitreal ranibizumab, 1 month apart (with dexamethasone if follow up OCT shows less than 10% improvement from baseline). Treatment was stopped when the treated eye achieved a central macular thickness of 250 microns or less with no focal parafoveal edema.

Final recorded central macular thickness in both groups compared to the baseline. By the end of the follow up period.

Final visual acuity was assessed in both groups compared to the baseline Change in final IOP, compared to baseline, in ranibizumab group and ranibizumab with dexamethasone group.

. The number of injections needed to achieve the same effect on CMT and BCVA.

Inclusion criteria

• Diabetic macular edema with central macular thickness of 300 μm or greater (as measured by spectral domain optical coherence tomography [OCT]).
• Best corrected visual acuity of 6/12 or less.

Exclusion criteria

• ● History of any treatment for DME (including grid or focal laser photocoagulation) within the last 6 months

• History of panretinal photocoagulation within the last 6 months.
• PDR as indicated with Fluorescein Angiography as it will require PRP which may affect DME.
• Macular ischemia, as indicated with Fluorescein Angiography.
• Cataract surgery within three months or cataract that requires surgical intervention during the follow-up period.
• Pseudophakia with Irvine Gass syndrome, as indicated with Fluorescein Angiography.
• Vitreomacular traction syndrome.
• Other causes of macular edema (eg. CRVO, CNV, uveitis, etc).
• Glaucoma, whether suspected or confirmed.
• Significant media opacity.
• Patients with ocular or periocular infections, or infection in the other eye
• Signs of Active or resolved uveitis and intraocular inflammation.
• Bad diabetic control as indicated by HbA1C >8.
• Renal impairment, hepatic impairment, or congestive heart failure.
• History of cardiovascular insult or stroke.