Despite no significant difference in the magnitude of absolute central subfield thickness reduction between the IV bevacizumab and IV ranibizumab groups, there was a higher proportion of eyes with a central subfield thickness ≤275 μm in the IV ranibizumab group compared with the IV bevacizumab group at all study follow-up visits; at weeks 4, 28, 36, and

44, this difference was statistically significant. Since reinjections were guided by this anatomic parameter (central subfield thickness), IV bevacizumab eyes were treated with a significantly higher mean number of intravitreal BAY 73-4506 injections (9.89) compared with IV ranibizumab eyes (7.67), yet achieved similar central subfield thickness

and BCVA outcomes compared with IV ranibizumab eyes at week 48. It is also important to point out a possible crossover this website effect of bevacizumab in the contralateral eyes of the 15 patients treated bilaterally, which may have positively influenced central subfield reduction in ranibizumab-treated contralateral eyes. However, there also may have been a crossover effect of ranibizumab. This potential crossover effect represents a limitation for studies that permit bilateral anti-VEGF treatment. The reinjection criterion (a central subfield thickness >275 μm) was based on data from patients with chronic DME that responded with favorable macular remodeling and were considered to demonstrate whatever “no fluid” on OCT after intravitreal anti-VEGF treatment (L. Barroso et al, unpublished data, November 2012). It has been reported that for patients with chronic DME, a lower central subfield thickness threshold value should be established in comparison to normal population values,22 and 23 probably because of some degree of central retinal atrophy related to previous laser or mild to moderate ischemia.24 Consistent with the latter report, in the

present study no patients with “no fluid” on OCT at week 48 had a central subfield thickness ≥275 μm. In addition, in the present study, among the 42 eyes that had any degree of concave foveal contour at week 48 despite some fluid on OCT, only 5 (12%) had a central subfield thickness >275 μm (L. Barroso et al, unpublished data, November 2012). No difference in intraocular pressure between the 2 groups was observed throughout the study, and no significant change in intraocular pressure was observed at any study visit compared with baseline in either group. The results of the current study are consistent with data from other studies that reported no apparent association between intravitreal anti-VEGF injection and increase in intraocular pressure,25 and 26 and are in contrast to some studies that have suggested such an association.