To determine the effect of adding topical ketorolac to bevacizumab in the treatment of diabetic macular edema (DME)

In a randomized clinical trial 50 eyes of 50 patients with DME and retinopathy severity less than proliferative diabetic retinopathy were randomly assigned to receive either intravitreal bevacizumab (IVB) or IVB plus topical ketorolac. BCVA, applanation tonometry, fundus examination, optical coherence tomography (OCT) were performed at baseline then 8, 14, 20 and 26 weeks after enrollment. Fluorescein angiography was carried out at baseline. IVB was injected monthly until 3 times then every 6 weeks if needed. Topical ketorolac was prescribed after first injection and continued until 6 months in the case group, the control group received topical artificial tear. Primary and secondary outcome measures were central macular thickness (CMT) and BCVA changes.

Baseline findings like HbA1c level, BCVA and CMT were not statistically different. While CMT was not significantly different between the groups 6 weeks after 3rd injection (IVB+ ketorolac: 390 ± 109µ, IVB: 385 ± 90µ, P= 0.892), but it was significantly less in the IVB+ ketorolac arm than in IVB arm at last visit (325 ± 61µ and 418 ± 117µ respectively, P= 0.001). Nonetheless, final BCVA improved meaningfully in both treatment arms, more in the IVB+ ketorolac arm compared to IVB arm (-0.17 ± 0.22 and -0.03 ± 0.27 logMAR, respectively), but the final BCVA was not statistically different between the groups (0.28 ± 0.21 and 0.37 ± 0.27 logMAR respectively, P= 0.095). The number of IVB injections was not significantly different between the arms (4.4 ± 1.0 and 4.4± 0.6 respectively, P = 0.730).

Adding up of topical ketorolac to anti-VEGF in DME treatment may increase the efficacy of therapy and decrease the CMT more. However, it did not have any significant effect on BCVA improvement.