Purpose: To compare the standard of care for DME and different combined treatment modalities in the context of its com- plex pathogenesis. To introduce novel therapeutic alternatives and to defy treatment algorithms in persistent and recurrent cases. Methods: A prospective study. Two groups of patients with combined treatment modalities were analyzed: 1st group treated with AntiVEGF and 2RT; 2nd group treated with Anti VEGF and Triamcinolon subtenonially. PRALC was added as needed. We used Nano- second laser 2RT (Ellex). For the purpose of the study we analyzed the structural (OCT) and functional (Angio-OCT-flow density (FD), BCVA) findings. OptoVue Avanti was used for AngioOCT and Snellen chart for BCVA. Results: There was no statistically significant im- provement in BCVA and CRT on the 1st, 3rd and 6th month in the 1st group after the treatment but a statistically significant improve- ment in FD on the 6th month was observed and elongation of treatment-free intervals: 78% of the patients were stable for more than 4 moths; only 22% needed a new injection in a less than 3 months. In the 2nd group there was statistically significant improvement in BCVA (0,44 to 0,62) and reduction in CRT (241 mcr ± 101 mcr). Conclusions: Combined treatment with AntiVEGF+Triamcinolon gives better functional and structural results compared to monthly anti-VEGF in resistant and recurrened case. The adjuvant treat- ment with 2RT has further stimulating effect on the retina and has the potential to slow the neuro-vascular and degenerative effects of diabetic retinopathy. The combined treatment has the potential to diminish the burden of monthly injections and improve compli- ance. The complex pathogenesis of DME needs combined approach.
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