J Korean Ophthalmol Soc.  2015 Aug;56(8):1223-1228. 10.3341/jkos.2015.56.8.1223.

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

• Kim CZ
• Nam KY
• Lee SU
• Lee SJ

• KMID: 2215074
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1223

Abstract

PURPOSE
To determine the effect of intravitreal bevacizumab injection before panretinal photocoagulation (PRP) in clinically significant macular edema (CSME) patients.
METHODS
A total of 91 eyes (70 patients) having severe nonproliferative diabetic retinopathy with CSME requiring PRP were enrolled in the present study; the medical records were retrospectively reviewed and analyzed. The eyes were divided into the regular 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 (microm) 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.

Keyword

Bevacizumab; Diabetic retinopathy; Macular edema; Panretinal photocoagulation

MeSH Terms

Diabetic Retinopathy
Endothelial Growth Factors
Humans
Light Coagulation*
Macular Edema*
Medical Records
Retrospective Studies
Visual Acuity
Bevacizumab
Endothelial Growth Factors

Figure

• 

  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.

Reference

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