Objective: To compare efficacy of intravitreal bevacizumab augmented with Panretinal photocoagulation versus Panretinal photocoagulation alone in high risk proliferative diabetic retinopathy. Methods: This is Randomized clinical control trial study conducted at ISRA University Hospital, Hyderabad from July 2018 to December 2018. A total of 76 eyes were randomized into two groups, 38 eyes undergone PRP plus intravitreal bevacizumab, while 38 eyes had PRP alone. Status of neovessels was assessed before and after treatment with the help of fundus fluorescein angiography. Neovessels at disc (NVD’s) and neovessels elsewhere (NVE’s) were assessed with the disc surface diameter. Results: Seventy-six eyes were enrolled in this randomized clinical trial into two groups consecutively, that all completed the six months follow-up. In the PRP group mean BCVA (logMAR) worsened significantly from mean 0.30±0.07 to mean 0.40±0.04 at a 30th day and mean 0.40±0.04 at day 90. While BCVA become improved from 0.30±0.05 to 0.1±0.03 at week four and 0.1±0.02 at week 12 in PRP-Plus group. There was significant change in regression of NVES in PRP only group at week 4 is 2.25±0.75 (p=0.00004) and at 12 weeks 2.00±0.50 (p=0.00002), while in PRP + intravitreal bevacizumab group at 4th week was 1±0.5 (p =0.0001) and at 12th week was 0.75±0.25 (p=0.0001). Conclusion: Intravitreal Bevacizumab augmented with PRP is more effective in early regression of neovessels in high risk PDR patients. doi: https://doi.org/10.12669/pjms.37.1.3141 How to cite this:Rebecca, Shaikh FF, Jatoi SM. Comparison of efficacy of combination therapy of an Intravitreal injection of bevacizumab and photocoagulation versus Pan Retinal Photocoagulation alone in High risk Proliferative Diabetic Retinopathy. Pak J Med Sci. 2021;37(1):157-161. doi: https://doi.org/10.12669/pjms.37.1.3141 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

One hundred cases of primary pterygium were treated with conjunctival autograft and Mitomycin C 0.02% intra-operatively for 5 minutes at the bare sclera by cotton swab. Anesthesia used was topical proparacaine and local infiltration of lignocaine. Patients were followed postoperatively for 9-12 months to find the recurrence (defined as fibrovascular tissues invading the cornea 1mm or more) of pterygium and complications. All surgeries were performed by one surgeon. RESULTS: Of the hundred cases 17 were lost in follow-up. In remaining eighty-three eyes received conjunctival autograft (CAG n=52) and Mitomycin C (MMC n=31). There were 4 (7.69%) recurrences in group A (CAG) and 8 (16.13%) recurrences in group B (MMC). There was statistically significant difference in the recurrence rate between the two groups. The post operative complications in MMC group were two punctate epithelial keratitis, one conjunctival granuloma and one has dellen. No significant complications were encountered in conjunctival autograft group. CONCLUSION: Simple excision of pterygium followed by conjunctival autograft has the lowest recurrence rate and minimal incidence of complications as compared to intraoperative Mitomycin C.

Objective: To monitor the effect of Intravitreal injection of bevacizumab on intraocular pressure in order to know whether intraocular pressure lowering medication or paracentesis is required prophylactically or thereafter. Subjects and methods: A prospective intervensional case series of 90 eyes with proliferative diabetic retinopathy and exudative Age related macular degeneration was done who received intravitreal injection of bevacizumab. Intraocular pressure was recorded with Goldman applantaion tonometer at baseline, and then after procedure at 5min, 30 min, 01 hours and 01 weeks. The pateints data was recorded of age, gender, disease, intraocular pressure, history of glaucoma, previous surgery, phakic status and topical and systemic medications. Results: The mean baseline intraocular pressure was found to be 13.54±2.1 in Proliferative diabetic retinopathy and 12.76±1.8 in Exudative Age related macular degeneration (p-value 0.046). The mean intraocular pressure elevation following Intravitreal bevacizumab at 5min was 32.89±6.3 in proliferative diabetic retinopathy and in exudative Age related macular degeneration was 32.18±5.7 (p-value 0.510), at 30 min was 16.71±2.6 and 15.53±2.4 (p-value <0.024), at one hour was 14.20±2.0 and 13.47±1.9 (p-value 0.095) and at one week 13.82±1.7 and 13.06±1.7 (p-value 0.126) in proliferative diabetic retinopathy and exudative Age related macular degeneration respectively. So there was no significant difference between the two diseases. Conclusion: There is abrupt and transient rise in the intraocular pressure following intravitreal injection of bevacizumab, but it did not remain elevated for longer duration hence there was no need of intraocular pressure lowering medication and paracentesis.

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