Panretinal photocoagulation combined with intravitreal bevacizumab in high-risk proliferative diabetic retinopathy.
OBJECTIVE
To evaluate the efficacy and safety of intravitreal bevacizumab as an adjunctive treatment to panretinal photocoagulation (PRP) for high-risk proliferative diabetic retinopathy with or without clinically significant macular edema (CSME).


METHODS
In forty-one eyes with high-risk proliferative diabetic retinopathy, intravitreal bevacizumab (1.25 mg/0.05 mL) before PRP (Plus group) or PRP alone (PRP group) was performed. Primary outcome measures were changes in best-corrected visual acuity and central macular thickness (CMT). Secondary outcome measures were the proportion of visual loss >/=0.1 logMAR, increase in CMT >/=50 mum, and eyes with development of vitreous hemorrhage.


RESULTS
Best-corrected visual acuity was significantly worse at 3 months (P = 0.041) in the PRP group, whereas in the plus group, there was no significant change. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.012, 0.008) in the Plus group, whereas in the PRP group, there was no significant change. In eyes with CSME, there was no significant change in best-corrected visual acuity in both groups. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.003, 0.001) in the Plus group, whereas in the PRP group, there was no significant change. In eyes without CSME, best-corrected visual acuity was significantly worse at 1 month and 3 months (P = 0.047, 0.011) in the PRP group, whereas in the Plus group, there was no significant change. Central macular thickness was significantly worse at 1 month and 3 months (P = 0.004, 0.016) in the PRP group, whereas in the Plus group, there was no significant change. In eyes without CSME, the proportion of eyes with visual loss >/=0.1 logMAR at 1 month was significantly higher in the PRP group than in the Plus group (P = 0.020). The proportion of eyes with development of vitreous hemorrhage was significantly lower in the Plus group than in the PRP group (P = 0.023).


CONCLUSIONS
Intravitreal bevacizumab before PRP can be an effective adjunctive treatment to PRP in the treatment of high-risk proliferative diabetic retinopathy, especially if there is not CSME.
Cho
Won Bin
WB
Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Oh
Se Beum
SB
Moon
Jun Woong
JW
Kim
Hyung Chan
HC
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003930:Diabetic Retinopathy / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation; D008266:Macula Lutea / Q000473:pathology; D008269:Macular Edema / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000209:etiology; D055815:Young Adult
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab