THE EFFICACY OF INTRAVITREAL DICLOFENAC 0.5MG /0.1 ML INJECTION IN THE MANAGEMENT OF REFRACTORY DIABETIC MACULAR EDEMA

Nour M. Al Adwan, MD., Rania Z. Rawashdeh MD., *Yazan T. Al Tarawneh MD., Lara Kh. Harahsheh MD., Emad Al Aqarbeh MD. and Ahmed E. Khatatbeh MD.

ABSTRACT

Aim: The aim is to evaluate the efficacy of intravitreal diclofenac sodium (0.5mg/0.1ml) in anti-VEGF-resistant diabetic macular edema (DME)-related patients and to assess functional and anatomical outcomes at one-month follow-up. Methods: This prospective single-center study was conducted at King Hussein Medical Center. All Patients with persistent DME (central macular thickness >350μm) despite a history of ≥6 anti-VEGF injections were enrolled int eh study. Participants underwent a complete ophthalmic evaluation, which included best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), and measurement of central macular thickness (CMT) using spectral-domain OCT, prior to and following one intravitreal diclofenac injection. We used paired t-tests for statistical analysis of continuous variables. Results: This study included 38 patients (45 eyes) with a mean age of 57.3 years. One-month post-injection, there were significant improvements; Mean CMT decreased from 412.5±58.3μm to 382.4±49.2μm (Δ=-30.1μm, 7.3% reduction, p<0.001) • BCVA improved from 0.72±0.18 to 0.65±0.17 logMAR (Δ=-0.07, ~3.5 letters ETDRS, p=0.003) • 62.2% of eyes (28/45) achieved ≥10% CMT reduction • 46.7% (21/45) gained ≥2 letters ETDRS There were no significant changes in IOP (15.3±2.1 mmHg vs 15.1±2.0 mmHg, p=0.421). There were two (4.4%) cases of transient conjunctival hyperemia that resolved spontaneously without intervention. Conclusion: In refractory diabetic macular edema, intravitreal diclofenac provided great efficacy with statistically and clinically significant changes in retinal thickness and visual acuity after 1 month. In addition, good safety profile and lack of intraocular pressure effects makes this procedure a good choice when anti-vascular endothelial growth factor are not effective or contra indicated.

Keywords: diabetic macular edema; treatment resistance; intravitreal diclofenac; non-steroidal anti-inflammatory; VEGF resistance.