Abstract
Purpose :
To report the progression of diabetic retinopathy (DR) in diabetic patients undergoing cataract surgery treated with intravitreal bevacizumab (BVB) and triamcinolone acetonide (TCA) at the time of surgery.
Methods :
A prospective, randomized, double-masked, parallel treatment comparison trial of diabetic patients with clinically significant cataract and fovea involving diabetic macular edema (DME), or a history of DME within 24 months of study entry. Participants were randomly allocated 1:1 to receive intravitreal BVB 1.25 mg or TCA 4 mg during cataract surgery and post operatively as needed. Detailed assessments were performed at baseline (before surgery), 1 week and monthly thereafter through to 6 months. Phacoemulsification and intraocular implantation were done using standard technique. DR was graded from fundus photographs by trained graders according to Early Treatment Diabetic Retinopathy Study (ETDRS) criteria, and categorized into mild, moderate, severe non-proliferative DR (NPDR) and proliferative DR (PDR). The rate of DR progression between groups were compared using chi-square test.
Results :
There were 61 eyes included in this analysis. Participants in both groups had similar baseline characteristics, except that those receiving BVB were older (70.2 vs. 64.3; P<0.05). There were 3 participants (10.7%) in BVB and 4 (12.1%) in TCA group that had 1 step progression, while none in BVB and only 1 (3%) in TCA group demonstrated 2 step DR progression. In the majority of these patients (6.5%), DR progression was from mild to moderate NPDR.
Conclusions :
In this study, there were no significant difference in terms of DR progression in groups treated with BVB or TA. Patients receiving BVB or TA had a lower rate of DR progression compared with previous studies in which no adjunctive treatment was administered. Our findings suggest that patients with DME may benefit from either intravitreal BVB or TCA injection at the time of cataract surgery to not only improve visual outcomes but also slow the expected deterioration of their DR following surgery.
This is a 2020 ARVO Annual Meeting abstract.