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Association of systemic comorbidity in diabetic serous macular detachment and comparison of various combination therapies in its management

Authors Soman M, Ganekal S, Nair U, Nair KGR

Received 18 September 2012

Accepted for publication 8 November 2012

Published 14 January 2013 Volume 2013:7 Pages 113—119

DOI https://doi.org/10.2147/OPTH.S38270

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Manoj Soman,1 Sunil Ganekal,2 Unnikrishnan Nair,1 KGR Nair1

1Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, 2Nayana Superspecialty Eye Hospital and Research Center, Davangere, Karnataka, India


Background: The purpose of this research was to study the association between systemic comorbidity in diabetic serous macular detachment (DSMD) and the effect of different forms of combination therapies in its management.
Methods: In this prospective analysis, 34 eyes from 34 patients with DSMD were investigated for the presence of systemic comorbidity including anemia, dyslipidemia, nephropathy, and cardiac disease, and treated with combination therapy of either intravitreal bevacizumab + laser (group 1, n = 14) or intravitreal triamcinolone + laser (group 2, n = 20). Sequential macular laser was done 2 weeks after intravitreal pharmacotherapy in both groups. Outcome measures included visual acuity and central foveal thickness at 1 and 3 months.
Results: The mean age of the patients was 55.6 ± 7.6 years. The commonest systemic association was nephropathy (82.3%). In group 1, mean visual acuity improved marginally from 6/17 at baseline to 6/16 at 1 month (P = 0.0001) and was maintained at 3 months (P = 0.008); and mean central foveal thickness decreased from 488.7 µm to 318.7 µm at 1 month (P = 0.0001) but increased to 414.4 µm at 3 months (P = 0.049). In group 2, mean visual acuity improved from 6/22 at baseline to 6/19 at 1 month (P = 0.0001) and 6/12 at 3 months (P = 0.0001); and mean central foveal thickness decreased from 428.8 µm to 323.8 µm at 1 month (P = 0.0001) to 269.2 µm at 3 months (P = 0.0001).
Conclusion: Nephropathy should be ruled out in patients with DSMD. Although at 1 month both intravitreal triamcinolone and bevacizumab improved vision and decreased central foveal thickness in eyes with DSMD when administered along with focal laser treatment, the former had a more long-lasting effect in maintaining this gain at 3 months.

Keywords: diabetic serous macular detachment, nephropathy, combination therapy

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