Visual Outcomes between Intravitreal Bevacizumab Versus Intravitreal Bevacizumab Plus Focal Laser among Patients with Diabetic Macular Edema at Kilimanjaro Christian Medical Centre 2021-2024

Abstract

Aim: To determine visual outcome in diabetic macular edema patients treated with bevacizumab alone versus bevacizumab plus focal laser. Study Design: A retrospective cohort study Place and Duration of Study: A 1 year follow-up, conducted at Kilimanjaro Christian Medical Centre from 2021 to 2024. Methodology: Patients with diabetic macular edema and satisfied the inclusion criteria were included in the study, those who received bevacizumab alone (120) were group one and those who combined with focal laser (116) were in group two. Visual acuity and central macular thickness at baseline, 6th week, 12th week, 18th week and 1 year were recorded in both groups. Results: Patients treated with bevacizumab plus focal laser had more improvement in mean visual acuity than bevacizumab alone. In bevacizumab plus focal laser group the mean visual acuity changed from baseline (0.63±0.5logMAR95%CI: 0.55-0.72) to end follow up (0.46±0.33logMAR95%CI: 0.40-0.52, P < .001). But in bevacizumab alone the mean visual outcome changed from baseline (0.86±0.9logMAR95%CI: 0.77-0.94) to end follow up (0.62±0.3logMAR95%CI: 0.55-0.69 P < .001. The mean macular thickness reduction was more in combined group than bevacizumab alone group from baseline (424.72±195.32um95%CI: 388.79-460.63), (453.48±155.61um95%CI: 425.36-481.61) to end of follow-up (277.14±63.84 um95%CI: 265.40-288.88 P < .001), (287.05±81.86 um 95%CI: 272.25-301.85 P < .001) respectively. Male gender was associated with lower functional success while good baseline visual acuity and shorter diabetes duration of less than 15 years significantly increased the likelihood of achieving functional success. Less number of intravitreal bevacizumab injections (≤3) was associated with good anatomical outcome. Conclusion: This study showed that the intravitreal bevacizumab plus focal laser group led to better visual outcomes over a 1year period compared to the bevacizumab alone group especially those with good baseline visual acuity, female gender, shorter diabetes duration of less than 15 years and less number of intravitreal bevacizumab injections (≤3).