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C. Moreira, A. F. Bordon, G. Z. Ramos, A. Raskin, V. C. Afonso, M. Harasawa, L. F. Q. S. Silveira, G. A. B. Pereira, C. Linhalis; Bevacizumab as an Adjuvant Treatment of Proliferative Diabetic Retinopathy: One Year Safety Results. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4240.
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To evaluate the long term efficacy and safety of intravitreal bevacizumab (IVB) prior to panphotocoagulation (PFC) in proliferative diabetic retinopathy (PDR). To assess the changes in visual acuity (VA) and central macular thickness (CMT) measured by optical coherence tomography (OCT).
prospective, interventional, non-controlled, non-randomized, open-label. Inclusion criterium: RDP. Main exclusion criteria: vitreous hemorrhage sufficient to preclude complete PFC, tractional retinal detachment equal or greater than 2 disc diameters, and thromboembolic event in the last 6 months. Eligible patients underwent a complete ophthalmologic examination. VA (ETDRS). Fluorescein angiography (FA) and OCT were performed at baseline and during follow-up visits. Patients received 2.5mg of IVB 7 to 15 days before the PFC. Criteria for retreatment of IVB: if any active neovascularization was found in follow-up after the completion of the PFC.
Twenty-one eyes of 17 patients were studied. Ten were female and 7 male. The mean age was 50.4 years (23-72). Four were type 1 diabetics and 13 were type 2. The mean duration of DM was 14.5 years. Mean follow-up was 205.7 days (90-480). Average VA at baseline was 0.5 logMAR and at the last follow-up 0.51 (p> 0.05). A complete or partial FA leakage decreased occurred about 7 to 15 days after IVB. The mean CMT by OCT was 279.9 µ + / -112.3 µ, µ 305.5 + / -131.8 µ, µ 247.8 + / -50.8 and 282.6 µ µ + / - 128.4 µ at baseline, 90, 180 days and last follow-up respectively. Statistical analysis of the macular thickness showed no statistically significant difference between the baseline compared with 90, 180 and last follow-up (p> 0.05). Three eyes required re-injection of IVB (rate 14.3%) due to recurrence of neovascularization: one patient (both eyes) in D90 and another patient (1 eye) in D180. None had significant worsening or developed tractional retinal or macular edema. There were no ocular or systemic adverse effects. There were no significant changes in IOP.
Although PFC can cause several disturbances, in our study with the use of IVB prior to PFC we did not find any of them. Moreover, there was no bleeding during the PFC that could have prevented his completion. This fact is attributed to IVB enhancing the treatment. Also, we did not observe significant loss of visual acuity neither macular thickening compared with baseline.
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