COMPARISON BETWEEN PANRETINAL PHOTOCOAGULATION AND PANRETINAL PHOTOCOAGULATION PLUS INTRAVITREAL BEVACIZUMAB IN PROLIFERATIVE DIABETIC RETINOPATHY

Mushtaq Ahmad, Sanaullah Jan

Abstract


Background: Patients with diabetes often develop ocular complications. The most common and most
blinding of these complications, however, is diabetic retinopathy. The objective of this study was to
compare the retinal neovessels regression in Proliferative Diabetic Retinopathy (PDR) treated with Pan
Retinal Photocoagulation (PRP) versus panretinal photocoagulation plus Intra Vitreal Bevacizumab
(IVB). Methods: A comparative study was conducted at Khyber Institute of Ophthalmic Medical
Sciences, Hayatabad Medical Complex, Peshawar from 1st October 2010 to 31st August 2011. A total
of 54 eyes were randomised into two groups. Neovessels status was assessed before and at every follow
up visit. Neo Vessels on the Disc (NVDs) were assessed as per percentage of NVD occupying the disc
surface whereas Neo Vessels Elsewhere (NVE) were also assessed as per reference to disc surface
diameter. Results: Neovascularization on the disc was 40±5% at presentation which increased to
50±7% on 30th day and stabilised to 40±6% on day 90 in PRP group. In PRP-plus group, 40±7% NVD
regressed to 10±5% on 30th day and 11±3% on day 90. The NVE in PRP group was 2±0.75% at
baseline, 2.25±0.75% on 30th day, and 2.00±0.50% on day 90. In PRP-plus group it was 2±0.50% at
baseline, 1±0.5% on day 30, and 0.75±0.25% on day 90. On day 90 both the groups had highly
significant different NVD (p=0.00008) and NVE (p=0.0001). Conclusion: Intra Vitreal Bevacizumab
in short term is effective as adjunctive treatment to PRP with early and higher rate of retinal neovessels
regression than PRP alone in PDR patients.
Keywords: Panretinal Photocoagulation, Diabetic Retinopathy, Intravitreal Bevacizumab

Full Text:

PDF

References


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.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]