Discussion
diabetic retinopathy, retinal tumors, retinal diseases, hyperglycemia, diabetes
DIABETIC RETINOPATHY, AGE-RELATED MACULAR DEGENERATION, RETINAL VEIN OCCLUSION, RETINAL DISEASES, PATHOPHYSIOLOGY, HYPERGLYCEMIA, ADVERSE EFFECTS, RETINA, INFLAMMATIONS, SCLERA, MACULAR EDEMA, DIABETES
This two-arm randomized pilot trial was conducted to evaluate the efficiency of adding a single dose of SCTA to IVB, as a popular anti-VEGF agent especially in developing countries, in managing CI-DME in treatment-naive eyes. The findings showed significant clinical and statistical improvements in BCVA and retinal anatomical outcomes in the eyes injected with this novel combination compared to in those receiving IVB.Today, anti-VEGF agents are commonly used as the first-line therapy for macular edema caused by retinal diseases such as age-related macular degeneration, retinal vein occlusion, certain retinal tumors and diabetic retinopathy [Reviewing the pathophysiology of DME can clarify the high unresponsiveness rates observed. Das et al. explained the pathophysiology of diabetic retinopathy by reporting four major biochemical mechanisms induced by hyperglycemia [Compared to IVB alone, IVB in combination with fusadil hydrochloride as a Rho/Rho kinase inhibitor was found by Ahmadieh et al. to cause better and prolonged visual outcomes and no significant adverse effects on patients with CI-DME [The properties of corticosteroids have been well addressed in literature. SCS lies between the choroid and sclera in healthy eyes. Exploring the safety and pharmacodynamics of SCTA injections in rabbit models, Chen et al. reported a significantly-higher drug concentration in the posterior retina than in the anterior segment. They also found that the resolution of both anterior and posterior segment inflammations was also significantly higher in suprachoroidal drug delivery compared to in posterior sub-tenon injection of TA [According to the Tanzanite clinical trial, SCTA plus intravitreal aflibercept (IVA) was well tolerated compared to IVA alone in patients with retinal vein occlusion. The number of injections also significantly decreased and BCVA and retinal thickness significantly improved in the combination arm [The present study limitations mainly comprised its small sample and relatively short-term follow-ups. Given the COVID-19 pandemic in Iran, the eight-week follow-up was not completed in the majority of the participants, resulting in unreliable data. Lack of a group with the combination injection of posterior subtenon triamcinolone acetonide and IVB was another limitation of this study.To the best of the authors’ knowledge, this study pioneered the investigation of the synergistic effects of SCTA and IVB in patients with diabetes. The strengths of the present research encompassed its randomization, the patients and evaluators masking to avoid possible bias, adherence to the study protocol and not depriving the patients from a confirmed treatment (ant-VEGFs). It is recommended that large clinical trials with longer-term follow-ups be performed to investigate the synergistic and sole effects of SCTA injections and report its potential adverse effects in patients with DME.