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D. L. Choi, D. J. Covert, J. E. Kim; Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1360.
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To evaluate the role of intravitreal bevacizumab (Avastin) in the treatment of active proliferative diabetic retinopathy (PDR) in eyes with and without prior panretinal photocoagulation (PRP).
Retrospective case series of patients with PDR, both with and without prior PRP, who were given intravitreal injections of bevacizumab on an as-needed basis. The following clinical outcomes were defined: I. Bevacizumab eliminated need for PRP within the observed follow up period; II. Bevacizumab delayed the need for PRP for a certain number of months, but PRP was eventually performed for persistent, recurrent or new neovascularization; III. Vitrectomy indicated within 6 weeks of bevacizumab injection; IV. PRP applied within 6 weeks of bevacizumab injection as part of planned combination therapy.
There were 23 eyes of 19 patients with 8 men and 11 women. Average age was 56.2+/-15 years (range: 27-84). Average follow-up was 12.1 months (range: 1-32) and average number of injections was 1.5 for all patients. Average follow-up was 9.92 months (range: 1-31) for the group without prior PRP and 14.6 months (range 1-29) for the group with prior PRP (p=0.23). Average number of injections was 1.58 for the group without prior PRP and 1.45 for the group with prior PRP (p=0.78). Of the 12 eyes without prior PRP, the following clinical outcomes were observed: I: 5 eyes (2-31 months); II: 3 eyes (PRP delayed 4-18 months); III: 0 eyes; IV: 4 eyes. Of the 11 eyes with prior PRP, the following clinical outcomes were observed: I: 3 eyes (4-23 months); II: 4 eyes (PRP delayed 4-16 months); III: 2 eyes; IV: 2 eyes. There was no statistically significant difference in the frequencies of these outcomes between eyes with and without prior PRP (chi-square p=0.39). The need for PRP was eliminated or delayed in 67% of eyes (8/12) that were PRP-naïve, 64% (7/11) of eyes that had prior PRP, and 65% (15/23) of eyes overall.
Intravitreal bevacizumab may have a role in patients with PDR whether or not prior PRP has been placed. Its use eliminated or delayed the need for PRP in the observed follow-up period in 65% of patients.
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