Combination therapy in diabetic macular oedema and retinal vein occlusion--past and present

Abstract

This paper summarizes the recent evidence for combined therapies in the intravitreal medical treatment of diabetic macular oedema or macular oedema, secondary to retinal vein occlusion. Since the introduction of anti-inflammatory or anti-VEGF drugs combined with or used alternatively to laser, visual acuity can be stabilized or improved in a significant number of patients. However, there is an ongoing debate regarding the safety, efficiency and economic concerns related to these intravitreal monotherapies because they warrant frequent repetition to maintain the clinical effect. In the literature, the combination of photolasercoagulation, intravitreal steroids or VEGF-inhibitors, or both, shows early compelling evidence that some patients may benefit from less retreatment compared to monotherapy. To provide a conceptual and perspective approach for a first-line combined therapy, this paper also summarizes own results of pilot interventional case series of a 1.5 cc core pars plana vitrectomy and intravitreal substitution with balanced salt solution (BSS), 1.25 mg bevacizumab and 8 mg triamcinolone.