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C. C. Zatezalo, K. E. Burleigh, R. M. Lieberman, R. M. Fischer; Treatment Comparison of Intravitreal Bevacizumab (Avastin®), Focal-grid Laser and Combination Therapy for Diabetic Macular Edema in a Diverse Clinic Population. Invest. Ophthalmol. Vis. Sci. 2009;50(13):185.
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To examine the efficacy and long-term outcomes in patients receiving either a single injection of intravitreal bevacizumab (Avastin®) (IVA), focal-grid laser (FGL) or combination therapy (CT) (IVA followed by FGL) for diabetic macular edema in a diverse clinic population.
A retrospective chart review of consecutive 119 patients (142 eyes) receiving IVA(1.25mg/0.05ml), FGL or CT was conducted. Data, including best corrected visual acuity (BCVA), central retinal thickness (CRT) via optical coherence topography, demographics, A1c, was collected at the time of treatment and at 1, 3, 6, and 12 months (mo). The main outcome measures included BCVA and CRT. BCVA at each visit was calculated and expressed in logMar and patient years. Within each cohort, patients were subgrouped by initial BCVA 20/20-20-40 (A), 20/50-20/150 (B), >20/200 (C).
119 patients (142 eyes); 62 Hispanics, 51 Asians, and 6 Blacks. Initial and final BCVA ranged from 20/20 to 20/400.-In the 79 eyes receiving FGL, the mean initial BCVA was 20/47.19; it was 20/41.7 at 1 mo, 20/47.71 at 3 mo, 20/40.57 at 6 mo and 20/41.89 at 12 mo. Initial mean CRT was 244.58um.-Forty-one eyes were treated with IVA. Mean BCVA was 20/122 at time of treatment, 20/82.24 at 1 mo, 20/80.26 at 3 mo, 20/76.92 at 6 mo and 20/75.89 at12 mo. There is statistically significant improvement in BCVA at 3 mo. (p=0.03) and 6 mo. (p=0.032). Initial mean CRT was 395um.-In the CT group (n=22), the mean initial BCVA was 20/83, 20/81.34 at 1 mo, 20/76.9 at 3 mo, 20/75.89 at 6 mo and 20/93.85 at 12 mo. Initial mean CRT was 340um.-The percent improvement of BCVA from presentation at 1 mo for FGT, IVA, CT was 14.4%, 21.8%, and 1.42% respectively; at 3 mo 1.3%, 21.8%, and 5.4%; at 6 mo 17.7%, 25.5% and 6.3%; and at 12 mo 14.2%, 26.2% and -8.5%. A1c ranged from 5.4%-14.1%: initial mean for each group was 8.3%, 7.6% and 7.85%.
Patients receiving FGL demonstrated stabilization of BCVA throughout all data points, even with the highest mean A1c. Although IVA showed statistically significant improvement in BCVA at 3 and 6 mo, the addition of laser (CT) did not appear to improve outcome. This underscores the need for timely treatment in all patient populations.
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