Abstract
OBJECTIVES:To investigate the effect of laser pan-retinal photocoagulation with or without intravitreal bevacizumab injections on macular choroidal thickness parameters in eyes with high-risk proliferative diabetic retinopathy.METHODS:High-risk proliferative diabetic retinopathy patients undergoing laser treatment were prospectively enrolled in this study. One eye was randomly selected for laser treatment combined with bevacizumab injections, study group, whereas the corresponding eye was subjected to laser treatment alone, control group. Spectral-domain optical coherence tomography with enhanced depth imaging was used to measure the macular choroidal thickness prior to and 1 month after treatment. Measurements in both groups were compared. Clinicaltrials.gov: NCT01389505.RESULTS:Nineteen patients (38 eyes) with a mean±standard deviation age of 53.4±9.3 years were evaluated, and choroidal thickness measurements for 15 patients were used for comparison. The greatest measurement before treatment was the subfoveal choroidal thickness (341.68±67.66 μm and 345.79±83.66 μm for the study and control groups, respectively). No significant difference between groups was found in terms of macular choroidal thickness measurements at baseline or after treatment. However, within-group comparisons revealed a significant increase in choroidal thickness parameters in 10 measurements in the study group and in only 5 temporal measurements in the control group when 1-month follow-up measurements were compared to baseline values.CONCLUSIONS:The macular choroidal thickness does not appear to be significantly influenced by laser treatment alone but increases significantly when associated with bevacizumab injections in patients with proliferative diabetic retinopathy and macular edema. Because bevacizumab injections reduce short-term laser pan-retinal photocoagulation-induced macular edema, our findings suggest that the choroid participates in its pathogenesis.
Highlights
Many researchers have used anti-vascular endothelial growth factor (VEGF) drugs such as intravitreal bevacizumab (IVB) injections with promising results to prevent the development of pan-retinal photocoagulation (PRP)-related ME [8, 9]
The fourth excluded patient had one eye excluded due to unreliable CT measurements, whereas the eye subjected to PRP and IVB injections was suitable for study
There is conflicting evidence on the effects of anti-VEGF agents on macular CT, even in patients not subjected to PRP
Summary
Diabetic retinopathy (DR) is one of its most common chronic microvascular complications [1] and one of the leading causes of new-onset blindness in industrialized and middle-income countries [2]. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are the primary disorders responsible for vision loss [3]. Laser pan-retinal photocoagulation (PRP) is the primary treatment modality for preventing vision loss in patients with PDR [4, 5]. PRP effectively reduces retinal neovascularization, it is associated with the release of cytokines, including vascular endothelial growth factor (VEGF), which may be related to adverse effects in the retina, including ME [6], thereby causing transient or permanent visual acuity [7,8,9] and contrast sensitivity loss [10]. Many researchers have used anti-VEGF drugs such as intravitreal bevacizumab (IVB) injections with promising results to prevent the development of PRP-related ME [8, 9]
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