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Comparing intravitreal bevacizumab, sub threshold macular laser (STML) and intravitreal dexamethasone implant (0.7mg) in the initial treatment of diabetic macular edema (DME) in a resident led clinic.

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Posterboard#: B0189

Abstract Number: 3681 - B0189

AuthorBlock: Mansoor Mughal1, Eileen Chang1, John Matthew Alexander1, Marcelle M. Morcos1
1Ophthalmology, Nassau University Medical Cent, East Meadow, New York, United States;

DisclosureBlock: Mansoor Mughal, None; Eileen Chang, None; John Matthew Alexander, None; Marcelle M. Morcos, None;

Purpose
Comparing intravitreal bevacizumab, sub threshold macular laser (STML) and intravitreal dexamethasone implant (0.7mg) in the initial treatment of diabetic macular edema (DME) in a resident led clinic. Comparison of three different approaches to the initial treatment of DME (Diabetic macular edema) in an initial pilot study. As cost and efficacy is extremely important in the setting of a public county hospital, we are comparing the efficacy of these treatments in our population.

Methods
Data collected on 25 eyes using retrospective chart review of patients presenting to the resident led Retina clinic with new onset DME. All patients received an initial baseline OCT with measurement of the central macular thickness (CMT), followed by either an intravitreal injection of bevacizumab, underwent sub threshold macular laser (STML – Iridex 532) , or were treated with intravitreal dexamethasone 0.7mg implant, with 1 month follow up. Response was monitored by change in BCVA and CMT.

Results
Total of 25 eyes received treatment with intravitreal injection of bevacizumab or sub threshold macular laser for new onset DME. Average preinjection CMT ranged from 310 to 705 in the injection group, with results suggesting an improvement in CMT of 220 to 402, representing 42% reduction in CMT (p<0.01). Average improvement in BCVA was 2 lines or better (p<0.02). In the subthreshold laser group response was not always present with 7 eyes in which CMT increased following treatment, and in those eyes in which there was an improvement, CMT changed from baseline only 12% (p<0.01). In the ozurdex group, improvement was slow but sustained over a 3 month period, however in 2 of 5 eyes there was an increase in intraocular pressure requiring additional IOP lowering medication.

Conclusions
In the resident led clinic, intravitreal injections are highly effective in the initial treatment of DME with excellent reduction in CMT, and BCVA compared to sub threshold macular laser, and intravitreal dexamethasone 0.7mg implants. Initial data from long term follow up however shows further reduction in CMT in the sub threshold laser group and intravitreal dexamethasone group, and shows promise as an adjunctive treatment for the long term management of DME.

Layman Abstract (optional): Provide a 50-200 word description of your work that non-scientists can understand. Describe the big picture and the implications of your findings, not the study itself and the associated details.
Diabetic macular edema (DME) is a very significant cause of visual loss across the globe. There are several therapeutic measures which can be employed in its treatment, including anti VEGF injections, sub threshold macular laser, and intravitreal dexamethasone implants. All of these treatments have varied efficacies and costs. In our study we have compared these treatment modalities for efficacy in our population of a resident led county hospital clinic in order to provide the most appropriate care for our DME population.