title: The effect of photocoagulation in ischemic areas to prevent recurrence of diabetic macular edema after intravitreal bevacizumab injection.
abstract: OBJECTIVE
  This study aimed to investigate whether targeted retinal photocoagulation (TRP) for nonperfused areas (NPAs) could have a preventive effect on the recurrence of diabetic macular edema (DME) after intravitreal injection of bevacizumab (IVB).
  
  
  METHODS
  Eyes in the IVB group received 1.25 mg IVB, and eyes in the IVB+TRP group received 1.25 mg IVB combined with TRP of NPAs. Two weeks before IVB administration, grid/focal photocoagulation (PC) had been performed in both groups. After IVB treatment, the best corrected visual acuity (BCVA) and central retinal thickness (CRT), determined by optical coherence tomography, were measured every month for 6 months.
  
  
  RESULTS
  Fifty-two patients with DME were enrolled and randomized to an IVB group (n = 26) and an IVB+TRP group (n = 26). After IVB, the CRT decreased temporally, and the CRT significantly increased at 2 months and thereafter in the IVB group but did not increase significantly in the IVB+TRP group. Maximum increase in CRT after IVB was significantly correlated with the width of NPAs in the IVB group (P = 0.0368), but not in the IVB+TRP group. Best corrected visual acuity in the IVB+TRP group was significantly better than that in the IVB group 5 and 6 months after treatment (P < 0.05).
  
  
  CONCLUSIONS
  Targeted retinal photocoagulation for NPAs was effective to maintain the reduced CRT after grid/focal PC and IVB for patients with DME. These results suggest that retinal ischemia is associated with the pathogenesis of recurrence of DME after IVB. ( www.umin.ac.jp/ctr number, UMIN000007566.).
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takamura
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tomomatsu
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Arimura
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Gozawa
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Takihara
authors.affiliation: Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Inatani
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D003930:Diabetic Retinopathy / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation / Q000379:methods*; D008269:Macular Edema / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012160:Retina / Q000187:drug effects / Q000473:pathology* / Q000601:surgery; D055502:Secondary Prevention; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
keywords: bevacizumab; diabetic macula edema; targeted retinal photocoagulation