The Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation in Patients with Clinically Significant Macular Edema

Chang Zoo Kim; Ki Yup Nam; Seung Uk Lee; Sang Joon Lee

doi:10.3341/jkos.2015.56.8.1223

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Kim, Nam, Lee, and Lee: The Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation in Patients with Clinically Significant Macular Edema

Original Article

J Korean Ophthalmol Soc 2015;56(8):1223-1228.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1223

The Effect of Intravitreal Bevacizumab Injection before Panretinal Photocoagulation in Patients with Clinically Significant Macular Edema

Chang Zoo Kim, M.D., Ki Yup Nam, M.D., PhD, Seung Uk Lee, M.D., PhD, Sang Joon Lee, M.D., PhD

Department of Ophthalmology and Institute of Medicine, Kosin University College of Medicine, Busan, Korea

Address reprint requests to Sang Joon Lee, MD, PhD Department of Ophthalmology, Kosin University Gospel Hospital, #262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6140, Fax: 82-51-990-3026 E-mail: hhiatus@gmail.com

∗ This study was presented as a narration at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 29 January 201518 March 2015 Accepted 1 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the effect of intravitreal bevacizumab injection before panretinal photocoagulation (PRP) in clinically sig-nificant macular edema (CSME) patients.

Methods

A total of 91 eyes (70 patients) having severe nonproliferative diabetic retinopathy with CSME requiring PRP were en-rolled in the present study; the medical records were retrospectively reviewed and analyzed. The eyes were divided into the reg-ular PRP group (51 eyes) and PRP with preinjection of bevacizumab (1.25 mg) group (combination group, 40 eyes) and compared. Best corrected visual acuity (BCVA) and central macular thickness (CMT) at pretreatment and 1, 3, 6, and 12 months after PRP was evaluated.

Results

BCVA (logarithm of the minimum angle of resolution, Snellen visual acuity in parentheses) at pretreatment and 1, 3, 6, and 12 months after PRP was 0.24 (0.575), 0.27 (0.537), 0.28 (0.525), 0.28 (0.525), and 0.30 (0.501) ( p = 0.13, 0.15, 0.56 and 0.79) in the regular PRP group and 0.32 (0.479), 0.25 (0.562), 0.26 (0.549), 0.27 (0.537), and 0.36 (0.436) ( p = 0.02, 0.04, 0.02 and 0.13) in the combination group, respectively. CMT (µm) at pretreatment and 1, 3, 6, and 12 months after PRP was 257.66, 285.16, 282.21, 289.65, and 309.85 ( p = 0.00, 0.00, 0.00 and 0.00) in the regular PRP group and 349.39, 312.17, 331.15. 353.30, and 333.55 ( p = 0.04, 0.94, 0.79 and 0.06) in the combination group, respectively.

Conclusions

Pretreatment of anti-vascular endothelial growth factor injection before PRP affected the decrease of macular thickness for 3 months after PRP and improved visual acuity for 6 months after PRP when compared with PRP alone in patients with CSME.

Keywords: Bevacizumab, Diabetic retinopathy, Macular edema, Panretinal photocoagulation

References

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Figure 1.

Photographs of fundus and optical coherence tomography. (A, B) Baseline evaluation of PRP only group (arrow: scan di-rection). (C, D) Baseline evaluation of AVI + PRP combination group (arrow: scan direction). PRP = panretinal photocoagulation; AVI = anti-vascular endothelial growth factor injection.

Figure 2.

Changes in best corrected visual acuity (BCVA) af-ter treatment in the two groups. Combination group shows sig-nificant improvement of BCVA for 6 months after treatment compared to baseline. log MAR = logarithm of minimum an-gle of resolution; PRP = panretinal photocoagulation; AVI = anti-vascular endothelial growth factor injection. ^* Compare to before injection, mean value reaches statistical significance ( p < 0.05). Tested by paired t-test.

Figure 3.

Changes in central macular thickness (CMT) after treatment in the two groups. Combination group shows sig-nificant reduction of CMT at 1 month after treatment com-pared to baseline. PRP = panretinal photocoagulation; AVI = anti-vascular endothelial growth factor injection. ^* Compare to before injection, mean value reaches statistical significance ( p < 0.05). Tested by paired t-test.

Table 1.

Basic characteristics of two groups

Variables	PRP only	AVI + PRP	p-value
Sex (M:F)	20:21	15:14	0.601^∗
Age (years)	58.65 ± 10.22	53.70 ± 11.10	0.030^†
BCVA (log MAR)	0.24 ± 0.25	0.32 ± 0.31	0.134^†
IOP (mm Hg)	14.46 ± 2.99	15.43 ± 2.94	0.264^†
CMT (μ m)	257.66 ± 54.31	349.39 ± 110.25	0.011^†
Duration of DM (years)	12.22 ± 7.86	13.86 ± 5.37	0.293^†
HbA1c (%)	7.92 ± 1.49	8.66 ± 2.22	0.125^†
Height (cm)	160.41 ± 8.40	158.59 ± 7.59	0.472^†
Weight (kg)	66.48 ± 21.38	58.85 ± 10.45	0.163^†
Hb (g/dL)	12.01 ± 1.69	12.30 ± 2.29	0.553^†
WBC (x10.e3/μ L)	7.87 ± 4.92	11.67 ± 15.39	0.184^†
PLT (x10.e3/μ L)	220.53 ± 40.15	242.55 ± 51.95	0.055^†
Hct (%)	35.04 ± 5.05	35.91 ± 6.64	0.544^†
TG (mg/dL)	193.09 ± 106.65	193.02 ± 108.06	0.998^†
Total cholesterol (mg/dL)	185.75 ± 47.21	179.88 ± 41.32	0.573^†
HDL (mg/dL)	40.01 ± 12.90	43.44 ± 11.98	0.246^†
BUN (mg/dL)	18.66 ± 6.28	22.47 ± 13.60	0.130^†
Cr (mg/dL)	1.04 ± 0.32	1.35 ± 1.13	0.125^†
GFR (mL/min/1.73m²)	66.83 ± 36.13	53.94 ± 36.15	0.115^†

Values are presented as mean ± SD unless otherwise indicated. PRP = panretinal photocoagulation; AVI = anti-vascular endothelial growth factor injection; BCVA = best corrected visual acuity; log MAR = logarithm of minimum angle of resolution; IOP = intraocular pressure; CMT = central macular thickness; DM = diabetes mellitus; HbA1c = glycosylated haemoglobin; Hb = hemoglobin; WBC = white blood cell; PLT = platelet; Hct = hematocrit; TG = triglyceride; HDL = high density lipoprotein; BUN = blood urea nitrogen; Cr = creatine; GFR = glomerular filtration rate.

^∗ Tested by Chi-square test;

^† Tested by independent two samples t-test.

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