Objectives: To see the effects of Intra-Vitreal Diclofenac injection (IVD) in refractory Diabetic Macular Edema (DME). Study Design: Quasi-experimental study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020. Methodology: Patients included in the study having Clinically Significant Macular Edema (CSME) with Central Macular Thickness (CMT) of more than 300 microns not responding to three consecutive Intravitreal injections of Bevacizumab (IVB).Intravitreal Diclofenac injection (500μg/0.1 ml) was given by the same retina fellow with the same protocol across all patients.Each patient was evaluated based on Central Macular Thickness (CMT) before intravitreal Diclofenac injection and on followup visits one week and one month after injection. Results: A total of 30 patients (30 eyes) were included in the study. Out of these, 11 were females, and 19 were males. The mean age of the patients was 57.87±4.424 years. Mean Central Macular Thickness (CMT) before injection was 439.67±110.45µm, after one week 398.47±110.55µm and 384.87±119.11µm after one month of intra-vitreal Diclofenac injection. Pre and post-injection central macular thickness (µm), which was clinically significant (p-value <0.001). Conclusion: Intravitreal Diclofenac injection (IVD) is effective in diabetic macular oedema, not responding to intravitreal antiVEGF (IVB) injections.

Objective: To investigate the effect of unilateral intravitreal Bevacizumab on contralateral eye in bilateral diabetic macular edema. Study Design: Quasi-experimental study. Place and Duration of Study: Retina Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from Sep to Dec 2020. Methodology: Thirty-two patients were enrolled with consecutive sampling. All the patients had clinically diagnosed diabetic macular edema having >275µm macular thickness on OCT. They were injected with 1.25mg/0.05mL of Bevacizumab in one eye. Baseline macular thickness was compared with 4 weeks follow up macular thickness, using Optical Coherence Tomography. Results: The central macular thickness in the untreated eye at baseline was 396.97 ± 29.79 µm and 388.34 ± 30.06 µm at 4 weeks (p-value=0.001). The difference in central macular thickness in treated and untreated eyes were 28.44 ± 4.11 µm and 19.81 ± 5.31 µm respectively (p-value = 0.001). There were statistically significant differences between these measurements. Conclusion: Injecting Bevacizumab in one eye for diabetic macular edema has statistically significant effect on the contralateral non-injected eye macular thickness.