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Case Report/Case Series |

Intravitreal Fasudil Combined With Bevacizumab for Persistent Diabetic Macular Edema:  A Novel Treatment

Hamid Ahmadieh, MD1; Ramin Nourinia, MD1; Ali Hafezi-Moghadam, MD, PhD2
[+] Author Affiliations
1Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Center for Excellence in Functional and Molecular Imaging, Brigham and Women’s Hospital, and Department of Radiology, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2013;131(7):923-924. doi:10.1001/jamaophthalmol.2013.143.
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Despite recent advances in pharmacotherapy for diabetic macular edema (DME), satisfying anatomical and visual results are not always achieved. Improved understanding of the mechanisms underlying diabetic retinopathy may pave the way for new treatment modalities for DME that is refractory to current therapies.

In addition to high vascular endothelial growth factor levels,1 increased activity of the Rho/ROCK pathway has recently been demonstrated in retinal vessels of diabetic rats.2 Experimental studies have demonstrated that fasudil hydrochloride, a potent ROCK inhibitor, can suppress leukocyte adhesion and prevent neutrophil-induced retinal endothelial cell damage.2

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Figure.
Retinal Images Taken Before and After Treatment

Retinal edema and foveal contour before and 6 weeks after combined therapy with intravitreal fasudil hydrochloride and bevacizumab in patient 2. A, Optical coherence tomography shows severe retinal edema with large cystoid spaces and absent foveal contour despite previous sessions of monotherapy with intravitreal bevacizumab. B, Optical coherence tomography demonstrates marked reduction of retinal edema and normalized foveal contour 6 weeks after combined treatment with intravitreal fasudil and bevacizumab. N indicates nasal and T, temporal.

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