Single-dose Intravitreal Bevacizumab after Complete Panretinal Photocoagulation in Proliferative Diabetic Retinopathy: an Effective Adjunctive Treatment
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 6 No. 3 (2017),
30 October 2017
Abstract
Patients with proliferative diabetic retinopathy (PDR) who are refractory to complete panretinal photocoagulation (PRP) have a high risk of severe vision loss. The aim of this study was to evaluate the effectiveness of single-dose intravitreal bevacizumab (IVB) after complete PRP in patients with refractory PDR. Patients with retinal neovascularization (NV) secondary to diabetes mellitus and refractory to complete PRP were enrolled in this study. All patients received a single dose of 1.25 mg IVB at 3 months after completing the PRP. Patients underwent complete ophthalmic evaluation and fluorescein angiography (FA) at baseline and 1 month after injection. The main outcome measure was a reduction in the areas of leakage (mm2) on FA. All patients were evaluated at baseline and on every visit at 1 day, 1 week, and 1 month after the injection. A total of 21 consecutive patients (32 eyes) with PDR completed this study. Thirteen (61.9%) patients were female. The mean ± standard deviation (SD) age was 64.1 ± 5.6 years. Complete and partial response of angiographic leakage of NV was noted in 7 (21.9%) and 18 (56.2%) of 32 eyes after a single IVB injection, respectively. No satisfactory response of retinal NV was observed in 7 eyes (21.9%) at 1 month after the injection. There was a significant difference in age between response groups (partial and complete; 61.9 ± 4.4 years) versus the no-satisfactory response group (67.7 ± 5.9 years) (P = 0.007). No significant ocular or systemic adverse events were observed. A single-dose of IVB could be associated with a satisfactory response of retinal NV, secondary to PDR, in patients who are refractory to complete PRP.ÂReferences
Shah CA. Diabetic retinopathy: A comprehensive review. Indian J Med Sci. 2008;62(12):500-19. PMID: 19265246
Zhang W, Liu H, Al-Shabrawey M, Caldwell RW, Caldwell RB. Inflammation and diabetic retinal microvascular complications. J Cardiovasc Dis Res. 2011;2(2):96-103. DOI: 10.4103/0975-3583.83035 PMID: 21814413
Adamis AP, Miller JW, Bernal MT, D'Amico DJ, Folkman J, Yeo TK, et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am J Ophthalmol. 1994;118(4):445-50. PMID: 7943121
Olsen TW. Anti-VEGF Pharmacotherapy as an Alternative to Panretinal Laser Photocoagulation for Proliferative Diabetic Retinopathy. JAMA. 2015;314(20):2135-6. DOI: 10.1001/jama.2015.15409 PMID: 26565713
Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331(22):1480-7. DOI: 10.1056/NEJM199412013 312203 PMID: 7526212
Sinawat S, Rattanapakorn T, Sanguansak T, Yospaiboon Y. Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation. Eye (Lond). 2013;27(12):1391-6. DOI: 10.1038/eye.2013.200 PMID: 24037235
Ferraz DA, Vasquez LM, Preti RC, Motta A, Sophie R, Bittencourt MG, et al. A randomized controlled trial of panretinal photocoagulation with and without intravitreal ranibizumab in treatment-naive eyes with non-high-risk proliferative diabetic retinopathy. Retina. 2015;35(2):280-7. DOI: 10.1097/IAE.00000000 00000363 PMID: 25272318
Simunovic MP, Maberley DA. ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR PROLIFERATIVE DIABETIC RETINOPATHY: A Systematic Review and Meta-Analysis. Retina. 2015;35(10):1931-42. DOI: 10.1097/IAE.0000000000000723 PMID: 2639 8553
Luo D, Zheng Z, Xu X, Fan Y, Zhu B, Liu K, et al. Systematic review of various laser intervention strategies for proliferative diabetic retinopathy. Expert Rev Med Devices. 2015;12(1):83-91. DOI: 10.1586/17 434440.2014.953057 PMID: 25154790
Kumar B, Gupta SK, Saxena R, Srivastava S. Current trends in the pharmacotherapy of diabetic retinopathy. J Postgrad Med. 2012;58(2):132-9. DOI: 10.4103/0022-3859.97176 PMID: 22718058
Shih T, Lindley C. Bevacizumab: an angiogenesis inhibitor for the treatment of solid malignancies. Clin Ther. 2006;28(11):1779-802. DOI: 10.1016/j.clinthera .2006.11.015 PMID: 17212999
Gross JG, Glassman AR. A Novel Treatment for Proliferative Diabetic Retinopathy: Anti-Vascular Endothelial Growth Factor Therapy. JAMA Ophthalmol. 2016;134(1):13-4. DOI: 10.1001/jamao phthalmol.2015.5079 PMID: 26583372
Ogata N, Nishikawa M, Nishimura T, Mitsuma Y, Matsumura M. Unbalanced vitreous levels of pigment epithelium-derived factor and vascular endothelial growth factor in diabetic retinopathy. Am J Ophthalmol. 2002;134(3):348-53. PMID: 12208245
Arevalo JF, Fromow-Guerra J, Sanchez JG, Maia M, Berrocal MH, Wu L, et al. Primary intravitreal bevacizumab for subfoveal choroidal neovascularization in age-related macular degeneration: results of the Pan-American Collaborative Retina Study Group at 12 months follow-up. Retina. 2008;28(10):1387-94. DOI: 10.1097/IAE.0b013e3181884ff4 PMID: 18827735
Spaide RF, Fisher YL. Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 2006;26(3):275-8. PMID: 16508426
Minnella AM, Savastano CM, Ziccardi L, Scupola A, Falsini B, Balestrazzi E. Intravitreal bevacizumab (Avastin) in proliferative diabetic retinopathy. Acta Ophthalmol. 2008;86(6):683-7. DOI: 10.1111/j.1600-0420.2007.01042.x PMID: 17995986
Seymenoglu RG, Ulusoy MO, Baser EF. Safety and efficacy of panretinal photocoagulation in patients with high-risk proliferative diabetic retinopathy using pattern scan laser versus conventional YAG laser. Kaohsiung J Med Sci. 2016;32(1):22-6. DOI: 10.1016/j.kjms.2015.12.002 PMID: 26853171
Tonello M, Costa RA, Almeida FP, Barbosa JC, Scott IU, Jorge R. Panretinal photocoagulation versus PRP plus intravitreal bevacizumab for high-risk proliferative diabetic retinopathy (IBeHi study). Acta Ophthalmol. 2008;86(4):385-9. DOI: 10.1111/j.1600-0420.2007.01 056.x PMID: 17995982
Pe'er J, Shweiki D, Itin A, Hemo I, Gnessin H, Keshet E. Hypoxia-induced expression of vascular endothelial growth factor by retinal cells is a common factor in neovascularizing ocular diseases. Lab Invest. 1995;72(6):638-45. PMID: 7540233
Witmer AN, Vrensen GF, Van Noorden CJ, Schlingemann RO. Vascular endothelial growth factors and angiogenesis in eye disease. Prog Retin Eye Res. 2003;22(1):1-29. PMID: 12597922
Gonzalez VH, Giuliari GP, Banda RM, Guel DA. Intravitreal injection of pegaptanib sodium for proliferative diabetic retinopathy. Br J Ophthalmol. 2009;93(11):1474-8. DOI: 10.1136/bjo.2008.155663 PMID: 19692371
Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, et al. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess. 2015;19(51):v-xxviii, 1-247. DOI: 10.3310/hta19510 PMID: 26173799
Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina. 2006;26(9):1006-13. DOI: 10.1097/01.iae.000024 6884.76018.63 PMID: 17151487
Arevalo JF, Wu L, Sanchez JG, Maia M, Saravia MJ, Fernandez CF, et al. Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy: 6-months follow-up. Eye (Lond). 2009;23(1):117-23. DOI: 10.1038/sj.eye.6702980 PMID: 17891058
Yang CS, Hung KC, Huang YM, Hsu WM. Intravitreal bevacizumab (Avastin) and panretinal photocoagulation in the treatment of high-risk proliferative diabetic retinopathy. J Ocul Pharmacol Ther. 2013;29(6):550-5. DOI: 10.1089/jop.2012.0202 PMID: 23495932
Cho WB, Oh SB, Moon JW, Kim HC. Panretinal photocoagulation combined with intravitreal bevacizumab in high-risk proliferative diabetic retinopathy. Retina. 2009;29(4):516-22. DOI: 10.1097/IAE.0b013e31819a5fc2 PMID: 19262436
Mason JO, 3rd, Yunker JJ, Vail R, McGwin G, Jr. Intravitreal bevacizumab (Avastin) prevention of panretinal photocoagulation-induced complications in patients with severe proliferative diabetic retinopathy. Retina. 2008;28(9):1319-24. DOI: 10.1097/IAE.0b013 e31818356fb PMID: 18667958
Schmidinger G, Maar N, Bolz M, Scholda C, Schmidt-Erfurth U. Repeated intravitreal bevacizumab (Avastin((R))) treatment of persistent new vessels in proliferative diabetic retinopathy after complete panretinal photocoagulation. Acta Ophthalmol. 2011;89(1):76-81. DOI: 10.1111/j.1755-3768.2009.0 1622.x PMID: 21272288
- Abstract Viewed: 2108 times
- Full Text PDF Downloaded: 1480 times