Improvement of Diabetic Macular Oedema with Intravitreal Dobesilate: A Case Report

Case Report

Austin J Clin Case Rep. 2014;1(10): 1046.

Improvement of Diabetic Macular Oedema with Intravitreal Dobesilate: A Case Report

Cuevas P1,2*, Outeiriño LA2, Azanza C2, Angulo J3 and Giménez-Gallego G4

1Faculty of Medicine, Universidad Alfonso X, Spain

2Department of Ophthalmology, Hospital Day Pius XII, Spain

3Department of Histology Facility Research, Hospital Universitario Ramón y Cajal, Spain

4Department of Structure and Function of Proteins, Center for Biological Research, Spain

*Corresponding author: Cuevas P, Faculty of Medicine, Universidad Alfonso X, Spain

Received: August 10, 2014; Accepted: September 10, 2014; Published: September 11, 2014


A single Intravitreal injection of Dobesilate seems to provide improvement in visual acuity and macular anatomy in a patient with diabetic macular oedema. To our knowledge, this is the first clinical case report using Intravitreal Dobesilate for diabetic macular oedema treatment. The therapeutic effect of Dobesilate may be due to the local inhibition of fibroblast growth factor.

Keywords: Diabetic retinopathy; Fibroblast growth factor; Dobesilate


BCVA: Best-Corrected Visual Acuity; DME: Diabetic Macular Oedema; DR: Diabetic Retinopathy; ELM: External Limiting Membrane; FGF: Fibroblast Growth Factor; IS: Inner Photoreceptor Segment; OS: Outer Photoreceptor Segment; RPE: Retinal Pigment Epithelium; SD-OCT: Spectral-Domain Optical Coherence Tomography

Case Presentation

A 51-years old Caucasian diabetic type 2 man presented with great visual impairment in both eyes, previously treated with Intravitreal Avastin injections with unsatisfactory results. Complete ophthalmologic examination (including slit-lamp bio microscopy, tonometry, Best Corrected Visual Acuity (BCVA) measurement, and Fundus examination) was performed at baseline and at subsequent visits every 2 months until month 8th after treatment. Anterior segment examination was normal in both eyes. Fundus examination revealed diabetic macular oedema in both eyes and atherosclerotic retinal vessels. BCVA was 0.20 (OD) and 0.30 (OS) respectively, and spectral-domain optical coherence tomography (SD-OCT) showed typical signs of cystoids diabetic macular oedema. Central foveal thickness, as revealed by SD-OCT, was 269 and 465μm in OD and OS, respectively. Treatment with intravitreal Dobesilate was recommended first in the OS eye. After approval of our Institution Scientific Board, the patient signed an informed consent form, which included a comprehensive description of Dobesilate and the treatment procedure. Patient received an intravitreal solution of Dobesilate (150μl) under sterile conditions, following the International Guidelines for intravitreal injections [1]. Dobesilate was administered as a 12.5% solution of diethylammonium 2,5-dihydroxibenzenesulfonate (Dycinone®, Sanofi-Aventis, Paris, France, EU). Antibiotic eye drops were then applied. Patient returned to the outpatient clinic for routine post injection follow-up. No ocular side effects upon administration of Dobesilate or during the following days were observed.

At baseline, SD-OCT showed significant macular oedema, with disintegration of the layered retinal structure and flattening of the central foveal depression. Several cystoids images were depicted (Figure 1A). Furthermore, the external limiting membrane (ELM), the inner segment and outer segment (IS/OS) photoreceptor junction appeared with disrupted integrity in some areas of the macula (Figure 1A). Morphological BCVA and SD-OCT data improved progressively along the follow-up. After 8 months of treatment, macular structure has improved, showing normal appearance and normal foveal depression; also the central macular thickness decreased to 203μm (Figure 1B) that was considered as normal, as in most referenced studies. Since integrity of IS/OS photoreceptor junction has a positive correlation with visual acuity [2,3] the appearance of the IS/OS photoreceptor junction depicted in Figure 1B suggested that intravitreal Dobesilate injection should have elicited a significant clinical improvement of the OS visual acuity. Effectively, 8 months after Dobesilate administration, visual acuity improved to 0.80.

Citation: Cuevas P, Outeiriño LA, Azanza C, Angulo J and Giménez-Gallego G. Improvement of Diabetic Macular Oedema with Intravitreal Dobesilate: A Case Report. Austin J Clin Case Rep. 2014;1(10): 1046. ISSN 2381-912X