Anatomically in Group the CMT decreased from preoperative values with

Anatomically, in Group 1; the CMT decreased from preoperative values with statistically significant reduction at all postoperative intervals until 6months (p<0.01). There was an average of 44.78% reduction in the mean CMT at the 2nd week and 34.67% reduction at the 6th month. In Group 2; the CMT decreased from preoperative values with statistically significant reduction at all postoperative intervals until 3months (p<0.01); but the difference in the mean CMT between preoperative and postoperative 6th months was not statistically significant (p>0.05). So we found combined IVTA and grid laser photocoagulation more successful in long term. Some other studies also reported a significant reduction in CMT in patients undergoing phacoemulsification surgery with intravitreal triamcinolone injection. Kang et al. applied macular grid photocoagulation after intravitreal triamcinolone acetonide for diffuse diabetic macular edema and found the CMT less than the normal upper limit (206μm) after 6months in 15 eyes of 44 eyes in the laser group and 6 of 19 in the control group. Although the exact mechanism underlying the maintenance of improved vision and decreased central macular thickness due to grid laser photocoagulation after IVTA was not precisely identified, Kang et al., speculate that decreased foveal thickness after IVTA facilitates the delivery of the laser gssg selectively to the photoreceptors and retinal pigment epithelia or steroids might act beneficially in the process of mature laser scar formation by suppressing inflammation caused by laser treatment. DRCR-net study indicated that intravitreal steroid or ranibizumab injections combined with laser treatment have a superior effect on VA improvement than laser treatment alone in diabetic macular edema (DME).
There are other treatment options such as intravitreal injections of antivascular endothelial growth factor (anti-VEGF) drugs or pars plana vitrectomy for DME. Ranibizumab and bevacizumab are the two main anti-VEGF drugs used commonly. Although ranibizumab has been recently approved by the United States Food and Drug Administration for the treatment of DME, it is expensive. Bevacizumab, which costs much less than ranibizumab, is commonly used off-label in treating DME. The results of studies comparing IVTA and intravitreal bevacizumab (IVB) in DME are controversial. Some studies found IVTA more effective than IVB, some the same and some less effective. A meta analysis shows that the group receiving IVTA has a statistically significant improvement in BCVA than the group receiving IVB in the first 3months. But the difference in BCVA was not observed at 6months. Also the side effects of IVTA such as elevation of IOP, cataract formation and risk of endophthalmitis cause limitations in their use.
The recent study by Cheema et al. revealed that after combined cataract surgery and intravitreal IVB, macular edema progressed only in 5.71% patients while 45.45% patients in control group. In the study by Wahab et al. it was reported that both grid laser and IVB in the management of cataract with macular edema due to diabetes mellitus and hypertension had a success rate of 60.5% in approaching visual acuity of 6/6. Ju Byung et al. compared the results of diabetic patients undergoing PHACO surgery receiving intraoperative IVB or not. They concluded that intravitreal ranibizumab injection at cataract surgery may prevent the postoperative worsening of macular edema and may improve gssg the final visual outcome.
Intravitreal steroid sustained release devices are being developed to achieve long-standing concentrations and less side effects. After a three year follow-up an 15 letter improvement of BCVA from baseline was detected in 22.2% of the patients receiving 0.7mg Dexamethasone implant (Ozurdex) and 18.4% of the patients receiving 0.35mg dexamethasone implant. The mean average reduction in CMT was −111.6 μm and 107.9 μm in the 0.7 mg and 0.35 mg dexamethasone implant receiving groups, respectively.