Objective: To evaluate the efficacy of intravitreal injection of bevacizumab combined with triamcinolone acetonide in diabetic papillopathy (DP).

Methods: A type 2 diabetic male with diabetic papillopathy in his right eye and drop in vision received a single injection of intravitreal bevacizumab combined with triamcinolone. Aqueous humor samples were collected just before the intravitreal injection. Four patients with DP (including said patient) were assessed for 7 cytokines and growth factors by multiplex bead assay. For control, aqueous humor was collected from 10 eyes before cataract sugery.

Results: Within one week of intravitreal injection vision improved from 6/30 to 6/7.5, and to 6/6 after 6 weeks which remained stable for 6 months of follow-up. No elevation of intraocular pressure beyond 21mmHg was noted at any time. In the aqueous of eyes with DP, the IL-6, IL-8, IL-1β, SAA, TGF-β, bFGF, and VEGF levels were significantly higher than in control eyes.(P<0.05 for all).

Conclusions: In our case, we first tried combined anti-VEGF and anti-inflammatory therapy for DP; the patient experienced rapid visual acuity improvement along with resolution of disc swelling. The favorable response to the treatment may suggest that angiogenesis cytokines and inflammatory elements could be involved in the pathogenesis of diabetic papillopathy. Furthermore, the positive results from the aqueous humor factors strongly support our treatment option. Consequently, intravitreal bevacizumab combined with intravitreal triamcinolone is a useful and reasonable treatment for diabetic papillopathy. Further larger clinical studies and prospective trials are required to properly evaluate the efficacy of intravitreal anti-VEGF combined with anti-inflammatory in the management of DP.