Advantages:

Intravitreal bevacizumab followed by laser micropulse in CSME offers a clear advantage of non-inducing a visible retinal burn and having a potential efficiency in reducing foveal thickness and visual acuity

Methods:

Prospective case series. One hundred and twenty cases of non-ischemic non-tractional CSME with macular thickness more than 400 microns as defined by OCT were managed by initial intravitreal bevacizumab injection of 1.25mg/0.1ml followed by laser micropulse using diode laser photocoagulation 3-4 weeks later at 15 % duty cycle with 1000 mW power and spot size of 75-125 microns. Laser micropulse is repeated in 3-4 months if residual leakage is observed. Follow up was maintained to 12 months. Our novel software labeling fundus imaging against areas of treatment designed by the author was used. Evaluation of treatment result was done using fluorescein angiography and OCT.

Effectiveness / Safety:

Bevacizumab was associated with decrease in central macular thickness from (447+/- 98 microns) to (326 +/- 53 microns) at 3-4 weeks follow up. Micropulse laser photocoagulation resulted in further improving central macular thickness at 3, 6 and 12 months to (268+/- 48 microns) in 77 cases (64 %). There were no associated retinal burn seen ophthalmoscopically, and only in few cases (8 cases), there was an association with fluorescein angiographic RPE window defect. Additional micropulse laser, repeated bevacizumab injection and vitrectomy was necessary in 36% of cases. Vision improved in 64 cases (53% of cases).

Take home message:

Initial intravitreal bevacizumab followed by micropulse laser is a useful minimal intensity effective therapy in management of selected cases of diffuse CSME.