AIM:To evaluate the therapeutic effect of aflibercept in patients with suboptimal response to ranibizumab therapy in the early period. ·METHOD: Thirty-eight patients with wet type agerelated macular degeneration( W-AMD) were involved in this study. Eighteen patients with suboptimal response were shifted to 3 doses monthly intravitreal aflibercept therapy ( IVA ) and left 20 patients with suboptimal response went on 3 more monthly intravitreal ranibizumab ( IVR ) . All changes were evaluated with fluorescein anigography ( FA ) and optical coherence tomography ( OCT) . ·RESULTS: Preoperative mean visual acuity ( VA ) and central macular thickness ( CMT) of patients were 0. 84 ± 0. 47 logMAR and 360 ± 84 μm, respectively. One month after last IVR and IVA treatments, VA of patients were 1.1±0.34 (P=0. 11) logMAR and 0. 48±0. 37 (P=0. 019) logMAR and CMTs were 300±79 μm (P=0. 002) and 271± 51 μm (P=0. 002), respectively. · CONCLUSION: To eliminate repeated therapy for patients with suboptimal response to ranibizumab therapy, aflibercept might be a good alternative for early visual rehabilitation.

AIM: To compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema.

METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab(IVB group)was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide(IVTA-IVB group)was performed. Main outcomes were the central macular thickness(CMT)measured with optical coherence tomography(OCT), ETDRS visual acuity(VA)and intraocular pressure(IOP).

RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 μm and 546.8±165.6 μm before injections; 430.4±133.2 μm and 363.7±105.3 μm in first month; 484.8±167.4 μm and 407.3±108.7 μm in 3^rd month; 550.4±191.5 μm and 516.8±158 μm after 6mo respectively. Differences were significant in first and 3^rd months(P<0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 in first month; 59±13.7 and 59.3±13.6 in 3^rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant in first and 3^rd and 6mo(P<0.05). There was no IOP difference. IVTA-IVB group gains best VA in 3^rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo.

CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.