Adjuvant topical dorzolamide or timolol with intravitreal bevacizumab for diabetic macular edema: A double-blind randomized controlled trial

Authors

  • Mohammadjavad Hafizi Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran https://orcid.org/0009-0000-2194-1326
  • Esmaeil Babaei Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  • Mohsen Gohari Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI:

https://doi.org/10.61882/jcbior.5.1.279

Keywords:

Diabetic macular edema, Timolol, Dorzolamide, Bevacizumab, Intravitreal

Abstract

Diabetic macular edema (DME) is a leading cause of visual impairment among diabetic patients, primarily managed with intravitreal anti-VEGF agents such as bevacizumab. However, the exploration of adjunctive therapies to enhance treatment outcomes remains an area of ongoing research. This study investigated the effects of adjuvant topical dorzolamide or timolol in combination with intravitreal Bevacizumab (IVB) injections for treating DME. In this study, 34 patients (68 eyes) with bilateral DME were randomized to receive either topical dorzolamide 2% or timolol 0.5% in one eye, along with IVB injections in both eyes. The contralateral eye served as a control, receiving only IVB injections. Central macular thickness (CMT) and visual acuity (VA) were assessed at baseline and one month after the third injection. Results showed statistically significant decreases in CMT for all three groups (dorzolamide, timolol, and control) post-treatment compared to baseline (p < 0.001). Similarly, VA decreased significantly in all groups (p < 0.001). However, there were no statistically significant differences in CMT or VA between the dorzolamide or timolol groups and the control group. Our findings suggest that the addition of topical dorzolamide or timolol to IVB injections does not provide significant additional benefits in reducing CMT or improving VA in DME patients. Further research with larger cohorts and extended follow-up periods is needed to fully elucidate the potential role of adjunctive topical therapy in DME management and to identify patient subgroups that may benefit from this approach.

References

1. Fazel F, Nikpour H, Pourazizi M. Combination of Intravitreal Bevacizumab and Topical Dorzolamide versus Intravitreal Bevacizumab Alone for Diabetic Macular Edema: A Randomized Contralateral Clinical Trial. Biomed Res Int. 2020;2020:6794391. DOI: 10.1155/2020/6794391 PMID: 32016118

2. Tatsumi T. Current Treatments for Diabetic Macular Edema. Int J Mol Sci. 2023;24(11):9591. DOI: 10.3390/ijms24119591 PMID: 37298544

3. Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of Diabetic Macular Edema. Curr Diab Rep. 2019;19(9):68. DOI: 10.1007/s11892-019-1188-4. PMID: 31359157

4. Ateeq A, Tahir MA, Cheema A, Dahri A, Tareen S. Intravitreal injection of Bevacizumab in diabetic macular edema. Pak J Med Sci. 2014;30(6):1383-7. DOI: 10.12669/pjms.306.5738 PMID: 25674143

5. Badawi AE, Mokbel TH, Elhefney EM, Hagras SM, Abdelhameed AG. Efficacy of topical dorzolamide 2% in diabetic cystoid macular edema. Int J Ophthalmol. 2021;14(9):1413-1418. DOI: 10.18240/ijo.2021.09.18 PMID: 34540619

6. Fekri S, Rabiei A, Hooshmandi S, Nouri H, Abtahi SH. The effect of combination therapy with intravitreal bevacizumab and topical timolol-dorzolamide eye drops on diabetic macular edema: a double-blind randomized controlled trial. Int Ophthalmol. 2024;44(1):101. DOI: 10.1007/s10792-024-03005-z PMID: 38376643

7. Zhang J, Zhang J, Zhang C, Zhang J, Gu L, Luo D, Qiu Q. Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications. Cells. 2022;11(21):3362. DOI: 10.3390/cells11213362 PMID: 36359761

8. Kempen JH, Sugar EA, Jaffe GJ, Acharya NR, Dunn JP, Elner SG, Lightman SL, Thorne JE, Vitale AT, Altaweel MM; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Fluorescein angiography versus optical coherence tomography for diagnosis of uveitic macular edema. Ophthalmology. 2013;120(9):1852-9. DOI: 10.1016/j.ophtha.2013.01.069 PMID: 23706700

9. Mirshahi A, Tadayoni R, Mohsenzadeh N, Saeidi Rezvani T, Abrishami M. Efficacy of adjuvant topical timolol-dorzolamide with intravitreal bevacizumab injection in diabetic macular edema: A contralateral eye study. J Curr Ophthalmol. 2019;31(2):168-171. DOI: 10.1016/j.joco.2019.01.008 PMID: 31317095

10. Gadwal SM, Madbouly WA, Mansour MN. The additive effect of topical Dorzolamide-Timolol with intravitreal ranibizumab injection in diabetic macular edema. Al-Azhar International Medical Journal. 2022;3(11):191-6. DOI: 10.21608/aimj.2022.166168.2216

11. Byeon SH, Kwon OW, Song JH, Kim SE, Park YS. Prolongation of activity of single intravitreal bevacizumab by adjuvant topical aqueous depressant (Timolol-Dorzolamide). Graefes Arch Clin Exp Ophthalmol. 2009;247(1):35-42. DOI: 10.1007/s00417-008-0917-1 PMID: 18682969

12. Nguyen QD, Shah SM, Khwaja AA, Channa R, Hatef E, Do DV, Boyer D, Heier JS, Abraham P, Thach AB, Lit ES, Foster BS, Kruger E, Dugel P, Chang T, Das A, Ciulla TA, Pollack JS, Lim JI, Eliott D, Campochiaro PA; READ-2 Study Group. Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology. 2010;117(11):2146-51. DOI: 10.1016/j.ophtha.2010.08.016 PMID: 20855114

13. Arevalo JF, Maia M, Flynn HW Jr, Saravia M, Avery RL, Wu L, Eid Farah M, Pieramici DJ, Berrocal MH, Sanchez JG. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92(2):213-6. DOI: 10.1136/bjo.2007.127142 PMID: 17965108

14. Diabetic Retinopathy Clinical Research Network; Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, Arnold-Bush B, Baker CW, Bressler NM, Browning DJ, Elman MJ, Ferris FL, Friedman SM, Melia M, Pieramici DJ, Sun JK, Beck RW. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193-203. DOI: 10.1056/NEJMoa1414264 PMID: 25692915

15. Cheema AA, Cheema HR. Diabetic Macular Edema Management: A Review of Anti-Vascular Endothelial Growth Factor (VEGF) Therapies. Cureus. 2024;16(1):e52676. DOI: 10.7759/cureus.52676 PMID: 38264181

16. Sadr A, Sargazi M, Banaie S, Asani M, Mehrad Majd H, Mohammadi SO, Maleki A. Topical Dorzolamide as Adjunctive Treatment With Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema. Cureus. 2024;16(2):e54829. DOI: 10.7759/cureus.54829 PMID: 38529446

Published

2024-03-30

Issue

Section

Original articles

How to Cite

Adjuvant topical dorzolamide or timolol with intravitreal bevacizumab for diabetic macular edema: A double-blind randomized controlled trial. (2024). Journal of Current Biomedical Reports, 5(1), 14-19. https://doi.org/10.61882/jcbior.5.1.279

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