Journal List > J Korean Ophthalmol Soc > v.56(8) > 1010052

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

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.

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.
jkos-56-1223f1.tif
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.
jkos-56-1223f2.tif
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.
jkos-56-1223f3.tif
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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