Diabetic Macular Edema (DME)
Today, many general ophthalmologist are practicing medical retina and are managing diabetic retinopathy
by themselves (not referring to vitreo-retinal surgeons). But is are no hard and fast rule on its management and different physicians tackle it differently.
There was a question posed and following were the responses:
Does anybody practice combining cataract surgery with IVTA (Intra Vitreal Triamconolone Acetonide) or IVB (IntraVitreal Bevacizumab or Avastin ) in cases Cataract with DME?
Please describe about experience, results and reservations, if any.
I do advocate 1-2 mg IVTA with cataract surgery in select patients of DME with significant cataract. Do not usually advise Avastin, unless obvious PDR is present.
Inflammation and CME being the major concerns, feel IVTA may be better here.
We do give pre operative ivta or ivb in cases of pre existing DME it prevents worsening of the edema due surgery at least.
I do practice IVTA with cataract surgery. But reserved for cases where cataract is very dense and requires removal to proceed for laser. IVB is reserved for PDR patients only.
Results are good and most cases do achieve flat dry macula in post-operative period. Not got any cases of endophth.
During the course of this discussion, a question was posed:
In a planned case of Intravit triamcinolone with cataract surgery if there is a PCR or ZD ,should we still go ahead with the steroid in the same sitting? The mixture of vitreous and viscoelastic does cause rise in IOP and steroid may increase it further. The crystals can come anteriorly and give a pseudo-endoph like appearance too. Will Avastin be better in such cases.
ivta is quite good even if you have a pc rent.prefer to inject from anterior route not pars plana. that way it stains the vitreous and enables very good anterior vitrectomy and gives a very quiet eye the next day. about crystals coming anteriorly- usually very little does and can be distinguished from inflammatory collection. Avastin has little anti inflammatory activity that is desirable in post op situation.
March 26, 2010 At Terminal 3 of Emirates in Dubai