الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
DME is the most common cause of visual impairment in patients with diabetes mellitus. The pathogenesis of DME is complex and multifactorial. It occurs mainly because of disruption of the BRB, which leads to increased accumulation of fluid within the intraretinal layers of the macula. DME can be diagnosed using noncontact stereoscopic biomicroscopy, contact lens biomicroscopy, FFA, and OCT. Focal/grid laser photocoagulation, the traditional standard of care in DME, is mostly associated with only vision stabilization, ETDRS showed that laser photocoagulation reduced the risk of moderate visual loss in patients with CSME by approximately 50%. The broad biologic activity and multiple pharmacologic effects of corticosteroids support the rationale behind its use for treatment for DME and Proliferative DR. Among the corticosteroids being used in managing the DR, triamcinolone acetonide (TA) is more popular. Several routes can administer TA, including intravitreal injection, periocular injection, posterior subtenon injection and intravitreal implant. Many authors have stressed the role that VEGFs play in promoting vascular permeability and accumulation of intracellular and extracellular fluid by disrupting the intercellular tight junctions normally present between retinal endothelial cells making treatment with anti-VEGF drugs an attractive therapeutic modality in DME. Anti-VEGF agents have been investigated in the treatment of DME, as Pegaptanib sodium (Macugen, Eyetech Pfizer), Ranibizumab (Lucentis, Genentech Inc., San Francisco, CA), and Bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA). Intravitreal bevacizumab has increasingly been used as a treatment for intraocular proliferative, edematous, and neovascular diseases, such as central retinal vein occlusion, neovascular glaucoma and recently, Intravitreal bevacizumab has been frequently applied to eyes with DME leading to an increase in visual acuity in some cases. The aim of this thesis is to compare the effectiveness and safety of intravitreal bevacizumab, ranibuzumab and aflipercipt intravitreal injection in the management of central involved DME. Sixty patients with type I or II diabetes mellitus complaining from central involved DME were recruited for this longitudinal study. All patients were subjected to complete history taking, complete ophthalmological examination, systemic evaluation, FFA and OCT imaging. Patients were subdivided according to the line of treatment they will receive, into three groups each group contained 20 patients ; ranibuzumab group, bevacizumab group and aflipercipt group, with followed up for 6 month.