title: Ranibizumab for diabetic macular edema difficult to treat with focal/grid laser.
abstract: BACKGROUND
  To evaluate the efficacy of intravitreal injections of ranibizumab in patients with diabetic clinically significant macular edema (CSME), when further focal or grid laser was considered to be unsafe.
  
  
  METHODS
  In this retrospective, interventional case study, intravitreal injections of ranibizumab were performed in 16 eyes (ten patients) suffering from diabetic retinopathy with CSME. All patients had been treated in the past with focal or grid laser. Additional photocoagulation could not be performed because the leaking points were very close to the avascular zone, and there was also a perifoveal capillary dropout. The patients underwent three injections (months 0, 1 and 2) and were followed monthly. Reinjection was performed if central retinal thickness (CRT) was ≥250 μm associated with fluorescein leakage involving the center of the macula.
  
  
  RESULTS
  The patients underwent a median of seven injections (range 6-9) and the median follow-up time was 11 months (range 9-15). The median best-corrected visual acuity (BCVA) was 0.85 logMAR at baseline and 0.54 logMAR at the end of the follow-up time (p = 0.018). BCVA improved in seven eyes (43.75%), remained stable in eight (50%) and decreased in one eye (6.25%). The median CRT decreased from 409.5 μm at baseline to 272 μm at the end of the follow-up time (p = 0.0002). No ocular or systemic adverse events were reported.
  
  
  CONCLUSIONS
  For a median follow-up time of 11 months, the treatment with intravitreal injections of ranibizumab resulted in stabilization or improvement of the visual acuity in the vast majority of patients with diabetic maculopathy and CSME, when further focal or grid laser was considered to be unsafe.
authors.affiliation: Department of Ophthalmology, Medical School of Athens University, 11 Zefiron St., 15342, Athens, Greece. thanoskotsolis@hotmail.com
authors.forename: Athanasios I
authors.initials: AI
authors.lastname: Kotsolis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tsianta
authors.forename: Maria
authors.initials: M
authors.lastname: Niskopoulou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Masaoutis
authors.forename: Stefanos
authors.initials: S
authors.lastname: Baltatzis
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Ladas
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000069579:Ranibizumab; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab