Long-term Effect of Panretinal Photocoagulation Combined With Intravitreal Bevacizumab in High-risk Proliferative Diabetic Retinopathy

Jun Ho Choi; Sung Jin Lee; Kyung Seek Choi

doi:10.3341/jkos.2010.51.6.842

Journal List > J Korean Ophthalmol Soc > v.51(6) > 1008838

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Choi, Lee, and Choi: Long-term Effect of Panretinal Photocoagulation Combined With Intravitreal Bevacizumab in High-risk Proliferative Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2010;51(6):842-848.

Published online: 3 August 2010

DOI: https://doi.org/10.3341/jkos.2010.51.6.842

Long-term Effect of Panretinal Photocoagulation Combined With Intravitreal Bevacizumab in High-risk Proliferative Diabetic Retinopathy

Jun Ho Choi, MD, Sung Jin Lee, MD, PhD, Kyung Seek Choi, MD, PhD

Department of Ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Kyung Seek Choi, MD, PhD Department of Ophthalmology, Soonchunhyang University Hospital #657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-798-7797, E-mail: ckseek@naver.com

Received 18 December 2009 Accepted 14 April 2010

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 evaluate long-term effects and usefulness of combined intravitreal injection of bevacizumab and panretinal photocoagulation (PRP) in patients with high-risk proliferative diabetic retinopathy.

Methods

The authors retrospectively reviewed the records of 40 patients (40 eyes) with high-risk proliferative diabetic retinopathy who had been treated with PRP alone (laser treatment group, n=20) or intravitreal bevacizumab before PRP (combined treatment group, n=20). Changes in best corrected visual acuity (BCVA), central macular thickness (CMT) and the total area of leakage from active new vessels (NVs) were compared between the groups at one, three, and six months and at one year post-treatment.

Results

In the combined treatment group, CMT decreased significantly at one month (p=0.021), and the areas of active NVs decreased significantly at one month (p=0.001) and three months (p=0.014) compared to those of the laser treatment group. However, there were no differences between the two groups after three months. In the combined treatment group, elevated intraocular pressures were found in three cases after one month, and there were vitreous hemorrhages in two cases after three months.

Conclusions

The combined treatment showed significant early improvements in BCVA, CMT, and NVs regression for up to three months. However, long-term follow-up and additional treatment was necessary in the patients with persistent or recurred NVs and macular edema after three months.

Keywords: Bevacizumab, High risk proliferative diabetic retinopathy (PDR), Proliferative diabetic retinopathy (PDR), Panretinal photocoagulation (PRP)

References

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Figure 1.

Changes in best corrected visual acuity (BCVA) after treatments in the two groups. There was no significant difference of changes in IOP between the groups at each visit. logMAR=logarithm of minimum angle of resolution.

Figure 2.

Changes in central macular thickness (CMT) after treatments in the two groups. Combined treatment group revealed significant reduction of CMT compared to laser treatment group at 1 month after treatment (p=0.021). There was no difference between the groups at the other visits. ^* Statistically significant differences between the two groups

Figure 3.

Changes in the total area of leakage from active new vessels (NVs) after treatments in the two groups. Combined treatment group revealed significant reduction in the area of active NVs compared to laser treatment group at 1 month (p=0.001) and 3 months (p=0.014) after treatment. However, There was no difference among groups at 6 months and 12 months ^* Statistically significant differences after treatment. between the two groups.

Table 1.

Baseline characteristics of two groups enrolled in the study

Characteristics	Combined treatment group	Laser treatment group	P value
	(20 eyes)	(20 eyes)
Age, years (Mean± SD)	53.5±10.5	55.7±12.1	0.643^*
Gender, n (Male : Female)	9 : 11	10 : 10	0.752^†
Duration of DM, years (Mean± SD)	10.5±6.9	9.6±4.8	0.896^*
HbA1c, % (Mean± SD)	7.43±2.1	7.25±2.02	0.835^*
Insulin treatment, n	15 (75%)	12 (60%)	0.311^†
Hypertension, n	8 (40%)	11 (55%)	0.342^†
CSME, n	11 (55%)	8 (40%)	0.342^†
Initial BCVA (logMAR)	0.51±0.49	0.29±0.31	0.224^*
Initial CMT, μm (Mean± SD)	315.6±94.1	262.3±50.7	0.100^*
Initial area of NVs, mm² (Mean± SD)	14.2±4.9	15.6±5.2	0.737^*

SD=standard deviation; DM=diabetes mellitus; HbA1c=glycosylated haemoglobin; CSME=clinically significant macular edema; BCVA=best corrected visual acuity; CMT=central macular thickness; NV=new vessels (area of leakage from active NVs).

^* Tested by Wilcoxon Signed Ranks Test;

^† Tested by Chi-square Test.

Table 2.

Best corrected visual acuity (BCVA), central macular thickness (CMT) and the total area of leakage from active new vessels (NVs) in the combined treatment group at each visit

Study period	BCVA	CMT	Area of NVs
	(logMAR, Mean± SD)	(μm, Mean± SD)	(mm², Mean± SD)
Baseline	0.51±0.49	315.6±94.1	14.23±4.83
1 Month	0.49±0.46	237.9±74.8^*	4.99±3.62^*
3 Months	0.39±0.40^*	283.0±75.3^*	4.37±2.74^*
6 Months	0.45±0.42	300.3±86.2	6.50±3.48^*
12 Months	0.49±0.41	296.4±86.8	8.47±3.71^*

SD=standard deviation; logMAR=logarithm of minimum angle of resolution.

^* Statistically significant change from baseline.

Table 3.

Best corrected visual acuity (BCVA), central macular thickness (CMT) and the total area of leakage from active new vessels (NVs) in the laser treatment group at each visit

Study period	BCVA	CMT	Area of NVs
	(logMAR, Mean± SD)	(μm, Mean± SD)	(mm2, Mean± SD)
Baseline	0.29±0.13	262.3±50.1	15.64±5.20
1 Month	0.31±0.15	285.8±46.2^*	10.33±3.62^*
3 Months	0.26±0.13	274.5±45.1	6.79±3.74^*
6 Months	0.28±0.14	266.6±71.6	7.09±3.43^*
12 Months	0.30±0.17	271.3±58.9	8.89±2.98^*

SD=standard deviation; logMAR=logarithm of minimum angle of resolution.

^* Statistically significant change from baseline.

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