Introduction
type 2 diabetes, vision loss, Diabetic retinopathy, vascular disease
DIABETIC RETINOPATHY, DIABETIC RETINOPATHY, VASCULAR DISEASE, DIABETIC MACULAR EDEMA, TYPE 2 DIABETES
Diabetic retinopathy and consequently diabetic macular edema (DME) remains the leading cause of vision loss particularly among older patients with type 2 diabetes [Intravitreal injection of anti-VEGF agents has revolutionized the treatment of DME. Ranibizumab represents a monoclonal antibody antigen-binding fragment, which is administered intravitreally to neutralize all isoforms of vascular endothelial growth factor A [Inflammatory mediators may participate in the progression of vascular disease in patients with diabetic retinopathy. Therefore, nonsteroidal anti-inflammatory drugs (NSAIDs) were suggested to be beneficial in the reduction of vascular permeability and accordingly in the management of diabetic macular edema. Moreover, topical NSAIDs have fewer side effects [Bromfenac is an NSAID with a topical formulation. Its mechanism of action is binding to and inhibiting the activity of cyclooxygenase II (COX II), precluding conversion of arachidonic acid to cyclic endoperoxides, which are precursors of prostaglandins (PG). Its specific differences in the pharmacodynamics and tissue penetration are the reason for its superiority over other agents in its class, in addition to its capability to penetrate into the posterior segment [Considering the high prevalence of DME and its challenging treatment, the present study was conducted to investigate whether addition of topical bromfenac to the intravitreal ranibizumab would promote its efficacy compared with intravitreal ranibizumab only.