Abstract
Purpose: :
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).
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: diabetic retinopathy • neovascularization • drug toxicity/drug effects