Abstract
Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P = 0.064), 1.11 (P = 0.000), and 1.11 (P = 0.002), and there was a mean loss of 2,6 (P = 0.055), 3.9 (P = 0.011), and 0.9 letters (P = 0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P = 0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.
Highlights
Diabetic retinopathy is one of the leading causes of blindness in the developed world, in patients aged 20 to 74 years [1]
The guidelines established by the ETDRS and DRS indicate the use of panretinal photocoagulation (PRP) in cases of proliferative diabetic retinopathy (PDR)
It has been reported that PRP alone can lead to a gain of two or more ETDRS lines in 45% of patients with severe macular oedema and PDR [23]
Summary
Diabetic retinopathy is one of the leading causes of blindness in the developed world, in patients aged 20 to 74 years [1]. Proliferative diabetic retinopathy (PDR) occurs in response to the ischaemiamediated release of vascular endothelial growth factor (VEGF) into the vitreous cavity [4,5,6]. It has been shown that retinal neovascularisation is a significant risk factor for severe vision loss in diabetic patients [4]. The Diabetic Retinopathy Study demonstrated that scatter laser panretinal photocoagulation (PRP) reduced the risk of severe vision loss by at least 50% in patients with highrisk PDR compared to a control group [7]. PRP is the principal therapy for sight-threatening PDR except for patients with a history of extensive vitreous haemorrhaging, which is a contraindication to laser photocoagulation
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