The present study was conducted at Mansoura Health Insurence Hospital, Mansoura, Egypt. The study included 136 eyes diabetic patients, 80 males 56 females. All eyes had diffuse diabetic macular edema (DME). The best corrected visual acuity was tested. Fluorescein angiography (FA) and OCT were preformed. The 136 eyes were divided into two groups. Group I included 72 eyes which were subjected to intravitreal injection of triamcinolone (4 mg, 0.1 cc) followed 3 weeks later by grid laser photocoagulation. Group II included 64 eyes which were subjected to intravitreal injection of ranibizumab (Lucentis) 0.5 mg, 0.1 cc followed 3 weeks later by grid laser photocoagulation. Grid laser treatment was performed using 100 µm spot size, 0.1 sec. exposure time, and the least power (100-30 mW) that induced light-grey retinal lesions. An area 500 µm around the fovea was spared. An area 3000 µm (2DD) around the fovea was treated. Fluorescein anagiography and OCT were performed one day before laser treatment, 4 weeks, 3 months and 6 months following laser treatment. The reduction of retinal thickening 3 weeks following intravenous injection before laser treatment was more pronounced in Group I (70% – 80%) than in Group II (60% – 70%) and therefore laser lesions could by produced with less power. 4 weeks, 3 months and 6 months following laser treatment OCT showed no difference between the two groups. The visual outcome was nearly the same in both groups. 28% of group I and 29% of group II showed considerable visual improvement. 39% of group I and 37% of Group II showed moderate improvement, while 33% of Group I and 34% of Group II showed no improvement 2 eyes of Group I developed posterior subcapsular cataract at the end of follow up period and 2 cases showed elevated IOP. No cases of infective or non-infective endophthalmitis were reported in both groups. The conclusion is that with a single injection before laser treatment triamcinolone is effective and has advantage of being cheap and the disadvantage of inducing cataract and IOP elevation. Renibizumab is also effective, does not induce cataract or IOP elevation, and is expected to be safe. If repeated injections are planned. Its main disadvantage is being expensive.

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