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


CONCLUSIONS
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.
Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala.
Manoj
M
Soman
Sunil
S
Ganekal
Unnikrishnan
U
Nair
Kgr
K
Nair
combination therapy; diabetic serous macular detachment; nephropathy