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

Abstract

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.

Importance of Combination of Intravitreal Bevacizumab and Panretinal Photocoagulation in Proliferative Diabetic Retinopathy

“…However, in the study performed by Jorge, D.M et al, 11 the male:female ratio in group A was 15:20, and 18:17 in group B, respectively. Whereas in the study performed by Rebbeca et al, 12 the male (%) and female (%) in group-A was 58.25 and 41.75, respectively while 62.96 and 37.04 in group B respectively. Further, in the investigation of Darabe, F et al, 13 He, F et al, 14 and Choi W et al, 15 no gender was considered as a prominent isolative factor.…”

“…However, after 24 weeks of follow-up, the reduction in VH score and BCVA were similar between both treatment strategies. Whereas in the study performed by Rebbeca et al, 12 they observed that, according to the improvement in results of BCVA and timing of regression of neovessels status after combined intravitreal bevacizumab injection and PRP demonstrated that intravitreal bevacizumab is a beneficial adjunctive treatment for high-risk PDR. Though multiple reinjections are required to maintain a visual improvement some patients have regression of retinal neovessels.…”

“…This condition is associated with a variety of macro and microvascular consequences.In the current study,a total of 180 cases were enrolled that further underwent different treatment regimes, i.e., Anti VEGF (Group-A), PRP (Group-C) and Anti VEGF + PRP both (Group-B). However, Jorge, D.M et al, 11 included 73 cases, Rebbeca et al, 12 included 76 eyes in their research. Darabe, F et al, 13 enrolled 90 patients for their investigation.…”

“…However, in the study performed by Jorge, D.M et al, 11 broad area of working age group was considered. Whereas in the study performed by Rebbeca et al, 12 the patients of 18-65 years age group were enrolled. Similarly, in the study by Darabe, F et al, 13 all patients aged ≥18 year who presented with first-time PDR with almost the same changes in both eyes with no prior retinal laser besides macular laser treatment were included.…”

Efficacy and safety of pan retinal photocoagulation combined with intravitreal anti-VEGF agents for high-risk proliferative diabetic retinopathy: A systematic review and meta-analysis

“…[23] When > 10 studies were identified, the risk www.md-journal.com of publication bias was assessed using a funnel plot of the obtained effect estimates. Overall, the 8 studies corresponded to 6 RCTs [24][25][26][27][28][29] and 2 retrospective studies. [30,31] There were 3 studies compared PRP plus intravitreal bevacizumab with PRP monotherapy, 4 studies compared PRP plus intravitreal ranibizumab with PRP monotherapy, and 1 study compared PRP plus intravitreal aflibercept with PRP monotherapy.…”