Abstract
Purpose: :
To report the long-term biologic effect of intravitreal bevacizumab (Avastin®) and triamcinolone acetonide in patients with retinal neovascularization secondary to diabetes mellitus and compare this drugs in diabetic macular edema.
Methods: :
Interventional, consecutive, retrospective, non-randomizaded, clinical case series examining.Forty-sevem eyes of 45 patients with proliferative diabetic rethinopathy (PDR) with neovascularization and/or macular edema.Thirty-six patients received intravitreal bevacizumab (AVA group) (1.25 mg-0.05ml) and eleven patients received intravitreal bevacizumab (1.25 mg-0.05ml) followed intravitreal injection of triamcinolone acetonide (AVA+TAAC group) (4 mg). Ophthalmic evaluations included nonstandardized Snellen visual acuity (VA), complete ophthalmic examination, fluorescein angiography, and optical coherence tomography.
Results: :
Mean follow-up was 11.36 months (range, 10-18). In the AVA group (n=36) 9 (36%) with neovascularization demonstrated by fluorescein angiography had partial reduction in leakage.The mean baseline visual acuity (BCVA) was 1.34 (logMAR), and the final mean BCVA was 1.11, a difference that was statistically significant (P<0.0001).In the AVA+TAAC group (n=11) mean BCVA was 1.15, and the final mean BCVA was 0.69.Macular edema analysis by both subgroups demonstrated that in AVA group 7/11 (63%) eyes remained stable, 2/11 (18%) improved _2 ETDRS lines of BCVA; mean central macular thickness at baseline by OCT was 380±142 µ and decreased to a mean of 354±167µ at end of follow-up. In AVA+TAAC subgroup (n=8) demonstrated that 1/8 (12.5%) eye remained stable and 2/8 (25%) improved _2 ETDRS lines. Mean central macular thickness at baseline by OCT was 407±50µ and decreased to a mean of 333±59µ at end of follow-up, a difference that was no statistically significant (P=0.5357)
Conclusions: :
Intravitreal injection of bevacizumab at dose of 1.25mg may benefit patients by improving visual acuity about one year follow up eyes in proliferative diabetic rethinopathy.Our results demonstrate that about one year follow up after single use of AVA vs. AVA+TAAC did not provide significant statistic difference for all patients with diabetic macular edema. A randomized clinical trial on this issue would provide more conclusive evidence and help identify those patients most likely to benefit from bevacizumab and intravitreal triamcinolone acetonide.
Keywords: diabetic retinopathy • diabetes • vascular endothelial growth factor