impact of bevacizumab in combination with pan-retinal photocoagulation in high risk proliferative diabetic retinopathy cases, comparative study

ABSTRACT

To evaluate the effects of Pan retinal photocoagulation [PRP] alone as a treatment of high risk Proliferative diabetic retinopathy [PDR] compared to the intravitreal Avastin injection in combination with PRP for the same cases. 60 patients were enrolled in this prospective randomized study as all patients were diagnosed as high risk PDR. The right eyes of all patients were treated by PRP full scatter and the left eyes were treated by 1.25 mg. Avastin injection in 0.1 ml two days prior also to full scatter PRP treatment in two sessions two weeks apart. Pre-treatment as well as post-treatment full ophthalmological assessment was done for all eyes in the two groups in the form of best corrected visual acuity[BCVA], Fluorescein Angiography, and also central foveal thickness by optical coherence tomography[OCT], all eyes were followed-up for one year. There was a significant difference between the PRP and the PRP assisted group in the area of fluorescein leakage from active neovascularization elsewhere [NVE]. As regards BCVA, there was a significant difference between the two groups at the end of follow-up period, favoring the PRP assisted group by at least two lines [P=0.05]. Also, the total area of actively leaking NVE's was significantly lower in PRP assisted group compared to the PRP group only [P<0.001]. The rate of complication in the form of vitreous hemorrhage and epiretinal membrane formation was also higher in the PRP group only but it was not statistically significant. The combined used of intravitreal Avastin with PRP for the high risk cases of PDR seems to give a more stabilized effect on the degree of PDR as well as on vision compared to the PRP treatment alone