COMPARISON BETWEEN PANRETINAL PHOTOCOAGULATION AND PANRETINAL PHOTOCOAGULATION PLUS INTRAVITREAL BEVACIZUMAB IN PROLIFERATIVE DIABETIC RETINOPATHY
Abstract
Background: Patients with diabetes often develop ocular complications. The most common and mostblinding of these complications, however, is diabetic retinopathy. The objective of this study was tocompare the retinal neovessels regression in Proliferative Diabetic Retinopathy (PDR) treated with PanRetinal Photocoagulation (PRP) versus panretinal photocoagulation plus Intra Vitreal Bevacizumab(IVB). Methods: A comparative study was conducted at Khyber Institute of Ophthalmic MedicalSciences, Hayatabad Medical Complex, Peshawar from 1st October 2010 to 31st August 2011. A totalof 54 eyes were randomised into two groups. Neovessels status was assessed before and at every followup visit. Neo Vessels on the Disc (NVDs) were assessed as per percentage of NVD occupying the discsurface whereas Neo Vessels Elsewhere (NVE) were also assessed as per reference to disc surfacediameter. Results: Neovascularization on the disc was 40±5% at presentation which increased to50±7% on 30th day and stabilised to 40±6% on day 90 in PRP group. In PRP-plus group, 40±7% NVDregressed to 10±5% on 30th day and 11±3% on day 90. The NVE in PRP group was 2±0.75% atbaseline, 2.25±0.75% on 30th day, and 2.00±0.50% on day 90. In PRP-plus group it was 2±0.50% atbaseline, 1±0.5% on day 30, and 0.75±0.25% on day 90. On day 90 both the groups had highlysignificant different NVD (p=0.00008) and NVE (p=0.0001). Conclusion: Intra Vitreal Bevacizumabin short term is effective as adjunctive treatment to PRP with early and higher rate of retinal neovesselsregression than PRP alone in PDR patients.Keywords: Panretinal Photocoagulation, Diabetic Retinopathy, Intravitreal BevacizumabReferences
Federman JL, Gouras P, Schubert H. Systemic diseases. In:
Podos SM, Yanoff M, (Eds). Retina and Vitreous: Textbook of
Ophthalmology. 9th ed. London: Elsevier Health Sciences;
p.7–24.
Bhavsar AR, Emerson GG, Emerson MV, Browning DJ.
Diabetic Retinopathy. In: Browning DJ. Epidemiology of
Diabetic Retinopathy. New York: Springer; 2010.
Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE. The
Wisconsin Epidemiologic Study of Diabetic Retinopathy XXIII:
the twenty-five-year incidence of macular edema in persons with
type 1 diabetes. Ophthalmology 2009;116(3):497–503.
Aiello LM, Cavallerano JD, Aiello LP, Bursell SE. Diabetic
retinopathy. In: Guyer DR, Yannuzzi LA, Chang S, Shields JA,
Green WR, (Eds). Retina Vitreous Macula. 1999;2:316–44.
Din Ju, Qureshi MB, Khan AJ, Khan MD, Ahmad K. Prevalence
of diabetic retinopathy among individuals screened positive for
diabetes in five community based eye camps in northern Karachi,
Pakistan. J Ayub Med Coll Abbottabad 2006;18(3):134–9.
Akduman L, Olk RJ. The early treatment for diabetic retinopathy
study. In: Kertes C, (Ed). Clinical Trials in Ophthalmology: A
Summary and Practice Guide. Baltimore: William &
Wilkins;1998. p.15–36.
Quillen DA, Gardner TW, Blankenship GW. Clinical Trials in
Ophthalmology: A Summary and Practice Guide. In: Kertes C,
(Ed). Diabetic Retinopathy study. Baltimore: William &
Wilkins;1998. p.1–14.
Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin
AA, Nasir MA, et al. Intravitreal Bevacizumab (Avastin) in the
treatment of proliferative diabetic retinopathy. Ophthalmology
;113(10):e1–15.
Tonello M, Costa RA, Almeida FP. Panretinal photocoagulation
versus PRP plus intravitreal bevacizumab for high-risk
proliferative diabetic retinopathy (IBeHi study). Acta Ophthalmol
;86:385–9.
Mason JO 3rd, Yunker JJ, Vail R. Intravitreal bevacizumab
(Avastin) prevention of panretinal photocoagulation-induced
complications in patients with severe proliferative diabetic
retinopathy. Retina 2008;28:1319–24.
Arevalo JF, Wu L, Sanchez JG, Maia M, Saravia MJ, Fernandez
CF, et al. Intravitreal bevacizumab (Avastin) for proliferative
diabetic retinopathy: 6-months follow-up. Eye 2009;23(1):117–23.
Soheilian M, Ramezani A, Obudi A, Bijanzadeh B, Salehipour
M
, Yaseri M, et al. Randomized trial of intravitreal bevacizumab
alone combined with triamcinolone versus macular
photocoagulation in diabetic macular edema. Ophthalmology
;116(6):1142–50.
J Ayub Med Coll Abbottabad 2012;24(3-4)
http://www.ayubmed.edu.pk/JAMC/24-3/Mushtaq.pdf 13
Kleiner RC, Elman MJ, Murphy RP, Ferris FL 3rd. Transient
severe visual loss after Panretinal photocoagulation. Am J
Ophthalmol 1988;106:298–306.
Adamis AP, Altaweel M, Bressler NM, Cunningham ET Jr,
Davis MD, Goldbaum M, et al. Changes in retinal
neovascularization after pegaptanib (Macugen) therapy in
diabetic individuals. Ophthalmology 2006;113:23–8.
Chen E, Park CH. Use of intravitreal bevacizumab as a
preoperative adjunct for tractional retinal detachment repair in
severe proliferative diabetic retinopathy. Retina
;26(6):699–700.
Isaacs TW, Barry C. Rapid resolution of severe disc new vessels
in proliferative diabetic retinopathy following a single intravitreal
injection of bevacizumab (Avastin). Clinical and Experimental
Ophthalmology 2006;34(8):802–3.
Friedlander SM, Welch RM. Vanishing disc neovascularization
following intravitreal bevacizumab (Avastin) injection. Archives
of Ophthalmology 2006;124(9):1365.
Cho WB, Moon JW, Kim HC. Panretinal photocoagulation
combined with intravitreal bevacizumab in high-risk proliferative
diabetic retinopathy. Retina 2009;29:516–22.
Jorge R, Costa RA, Calucci D. Intravitreal bevacizumab
(Avastin) for persistent new vessels in diabetic retinopathy
(IBEPE study). Retina 2006;26:1006–13.
Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris
neovascularization after intravitreal injection of bevacizumab in
patients with proliferative diabetic retinopathy. Am J Ophthalmol
;142:155–8.
Mirshahi A, Roohipoor R, Lashay A. Bevacizumab-augmented
retinal laser photocoagulation in proliferative diabetic
retinopathy: a randomized double-masked clinical trial. Eur J
Ophthalmol 2008;18:263–9.
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