Intravitreal bevacizumab versus combined bevacizumab-triamcinolone versus macular laser photocoagulation in diabetic macular edema.

PURPOSE: To evaluate the additive effect of triamcinolone to bevacizumab in comparison to standard macular laser photocoagulation versus bevacizumab in the management of diabetic macular edema (DME). METHODS: In a prospective, randomized clinical trial, 130 eyes of 110 patients with type 2 diabetes with DME were included. Eligible eyes were randomly assigned to 1.25 mg intravitreal bevacizumab (42 eyes) (IVB group) or combination of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide (41 eyes) (IVB+IVT group) or macular laser photocoagulation (47 eyes) (MPC). Central macular thickness (CMT) and visual acuity changes at week 6 and 16 were assessed. RESULTS: The mean age of the patients was 57 -/+7 years. Patients were followed 16 weeks. At week 6, all the three groups showed significant reduction in CMT but the reductions for IVB and IVB+IVT were significantly more than MPC (p<0.001). At week 16, the response was not stable for IVB (p<0.001), but IVB+IVT maintained its superior status to MPC (p<0.001). At week 16, visual acuities were essentially unchanged for the two groups of MPC and IVB and improvement for IVB+IVT was marginal and at most was 0.1 log MAR. No patient developed uveitis, endophthalmitis, or thromboembolic event. CONCLUSIONS: Single intravitreal bevacizumab or triamcinolone plus bevacizumab injection brought about significantly greater macular thickness reduction in diabetic patients in comparison to standard laser treatment. However, the response for bevacizumab alone was short-lived. Reduction in macular thickness was only marginally associated with visual acuity improvement in the triamcinolone plus bevacizumab injection group.

Incidence and risk factors of retinopathy of prematurity in a tertiary eye hospital in Tehran.

AIM: To determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature infants referred to a tertiary eye hospital during 2003-7 to provide preliminary evidence about ROP in Iran. METHODS: In a cross-sectional study, data for premature infants screened for ROP in Farabi Eye Hospital including possible risk factors and eye exams' results were recorded and analysed using chi(2), univariate and multiple regressions. Severe ROP was defined as ROP needing treatment or stage 4 or 5 of ROP. RESULTS: Among 953 premature infants, there were 329 (34.5%) different stages of ROP. Severe ROP was seen in 22.6% (215/953) of infants (16.5%: treatable, 6.1%: advanced untreatable). The mean gestational age (GA) and birth weight (BW) of infants with severe ROP were 28.8 (SD 2.4) weeks and 1256 (389) g respectively. Univariate analysis showed a significant relation between GA, BW, oxygen therapy, blood transfusion and ROP (p<0.001), while multiple-regression methods showed GA, BW and oxygen therapy as independent predictors of ROP (p<0.001, 0.019 and 0.033, respectively). CONCLUSION: The authors observed a relatively high incidence of ROP in this series, especially its severe form affecting relatively more mature infants, which merits further investigation. GA, BW and oxygen therapy were independent ROP determinants.

Bevacizumab-augmented retinal laser photocoagulation in proliferative diabetic retinopathy: a randomized double-masked clinical trial.

PURPOSE: To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy. METHODS: A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion. RESULTS: The median age was 52 years (range: 39-68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (p<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033). CONCLUSIONS: Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.

Surgical induction of chorioretinal venous anastomosis in ischaemic central retinal vein occlusion: a non-randomised controlled clinical trial.

AIM: To evaluate the safety and efficacy of surgical induction of chorioretinal venous anastomosis in the management of ischaemic central retinal vein occlusion (CRVO). METHODS: In a comparative clinical trial, 28 patients with ischaemic CRVO were included, of whom 18 who declined surgery were considered as controls. The 10 surgical cases underwent standard vitrectomy with incisions into the choroids adjacent to the partially cut major retinal veins. Mersilene suture insertion was done to induce chorioretinal venous shunt. Mild endolaser was applied. Patients were followed up for 6-18 (mean 10) months. RESULTS: Clinical success in shunt development was 90%. Surgical cases had a significantly better visual acuity improvement compared with controls (mean difference: 1.5 logMAR, p = 0.001) with 80% of them showing improvement (compared with 28% of the controls, p = 0.016). Neovascularisation developed in 39% of the control group compared with 0% of the surgical cases (p = 0.03). In multivariate analysis, surgery remained the sole significant predictor of visual improvement. There were three re-operations for vitreous cavity haemorrhage, cataract, and retinal detachment. CONCLUSIONS: Surgical induction of chorioretinal venous anastomosis may result in visual acuity improvement and prevent neovascularisation in ischaemic CRVO. Randomised studies are needed to compare the current study modality with the natural course of CRVO and emerging procedures, such as optic neurotomy, in the management of ischaemic CRVO.