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2014, Number 1

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Rev Cub Oftal 2014; 27 (1)

Panretinal photocoagulation and intravitreal bevacizumab in the treatment of active proliferative diabetic retinopathy

Hernández PA, Tirado MOM

Language: Spanish
References: 39
Page: 4-15
PDF size: 156.46 Kb.


ABSTRACT

Objective: to evaluate the effect of panretinal photocoagulation and intravitreal injection of bevacizumab on neovascularization areas of patients with active proliferative diabetic retinopathy.
Methods: experimental study conducted in 80 eyes from 62 patients with proliferative diabetic retinopathy with high risk characteristics. These patients were randomly assigned to panretinal photocoagulation group (group L) or to the panretinal photocoagulation plus intravitreal bevacizumab group (group L + B). The studied variables were age, sex, race, type of diabetes mellitus, illness duration, type of treatment, fluorescein distribution area and retinal/optical disc neovascularization regression area. They were followed-up for 9 months.
Results: in the initial evaluation, the average diffusion area was 8,95 mm2 in group L and 10,08 mm2 in group L + B (p= 0,347), which changed to 6,40 mm2 and 3,91 mm2 (p = 0,012) respectively, after one month; 3,15 mm2 and 1,02 mm2 (p = 0,002) three months later, 2,45 mm2 and 0,58 mm2 (p = 0,001) after six months and 2,18 mm2 and 0,46 mm2 (p = 0,001) after nine months, respectively. The analysis of absolute differences of averages showed a significant reduction in the distribution areas of fluorescein that favored the combined therapy.
Conclusions: in patients with active proliferative diabetic retinopathy, intravitreal bevacizumab combined with panretinal photocoagulation bring about dramatic regression of neovascularization, which remained stable from the third to the ninth month.


REFERENCES

  1. Pareja Ríos A, Serrano García MA, Marrero Saavedra MD, et al. Guías de práctica clínica de la SERV: manejo de las complicaciones oculares de la diabetes. Retinopatía diabética y edema macular. Arch Soc Esp Oftalmol. 2009;84(9):429-50.

  2. Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States. JAMA. 2010;304(6):649-56.

  3. Crespo N, Padilla JC, González R, Crespo N, Rodríguez M, Hernández JD. Prevalencia de la retinopatía diabética en pacientes del nivel primario de salud. Rev Cubana Med Gen Integr. 2004;20(2):111.

  4. Abdallah W, Fawzi AA. Anti-VEGF therapy in proliferative diabetic retinopathy. Int Ophthalmol Clin. 2009;49(2):95-107.

  5. Carmeliet P. Mechanisms of angiogenesis and arteriogenesis. Nat Med. 2000;6:389-95.

  6. Gunther JB, Altaweel MM. Bevacizumab (Avastin) for the Treatment of Ocular Disease. Surv Ophthalmol. 2009;54:372-400.

  7. Adamis AP, Altaweel M, Bressler NM. Macugen Diabetic Retinopathy Study Group. Changes in retinal neovascularization after pegaptanib (Macugen) therapy in diabetic individuals. Ophthalmology 2006;113:238.

  8. 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.

  9. Avery RL, Pearlman J, Pieramici DJ. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006;113(10):16-95.

  10. Avery RL. Regression of retinal and iris neovascularization after intravitreal bevacizumab (Avastin) treatment. Retina. 2006;26:352-4.

  11. Wu L. Bevacizumab Intravítreo (Avastin®). En: Retinopatía Diabética: Resultados del Grupo Panamericano de Estudio Colaborativo de Retina (PACORES). Vision Pan- America. The Pan-American Journal of Ophthalmology. 2012;11(3):709.

  12. Shahr J, Avery RL, Heilweil G, Barak A, Zemel E, Lewis GP, et al. Electrophysiologic and retinal penetration studies following intravitreal injection of bevacizumab (Avastin). Retina. 2006;26:262-9.

  13. Han XX, Guo CM, Li Y, Hui YN. Effects of bevacizumab on the neovascular membrane of proliferative diabetic retinopathy: reduction of endothelial cells and expressions of VEGF and HIF-1. Mol Vis. 2012;18:19.

  14. Chung EJ, Kang SJ, Koo JS, Choi YJ, Grossniklaus HE, Koh HJ.Effect of intravitreal bevacizumab on vascular endothelial growth factor expression in patients with proliferative diabetic retinopathy. Yonsei Med J. 2011;52(1):151-7.

  15. Jeon S, Lee WK. Intravitreal bevacizumab increases intraocular interleukin-6 levels at 1 day after injection in patients with proliferative diabetic retinopathy. Cytokine. 2012;60(2):535-9.

  16. Shin YW, Lee YJ, Lee BR, Cho HY. Effects of an Intravitreal Bevacizumab Injection Combined With Panretinal Photocoagulation on High-Risk Proliferative Diabetic Retinopathy. Korean J Ophthalmol. 2009;23:266-72.

  17. Isaacs TW, Barry C. Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab (Avastin). Clin Experiment Ophthalmol. 2006;34(8):802-3.

  18. Bakri SJ, Donaldson MJ, Link TP. Rapid regression of disc neovascularization in a patient with proliferative diabetic retinopathy following adjunctive intravitreal bevacizumab. Eye. 2006;20(12):1474-5.

  19. Mirshahi A, Roohipoor R, Lashay A, Mohammadi SF, Abdoallahi A, Faghihi H. Bevacizumab-augmented retinal laser photocoagulation in proliferative diabetic retinopathy: A randomized double-masked clinical trial. Eur J Ophthalmol. 2008;18(2):263-9.

  20. 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.

  21. Minnella AM, Savastano CM, Ziccardi L, Scupola A, Falsini B, et al. Intravitreal bevacizumab (Avastin) in proliferative diabetic retinopathy. Acta Ophthalmol. 2008;86(6):683-7.

  22. Arévalo JF, Wu L, Sánchez JG, Maia M, Saravia MJ, Fernández CF, et al. Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy: 6-months follow-up. Eye. 2009;23(1):117-23.

  23. Mason JO, Nixon PA, White MF. Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol. 2006;142(4):685-8.

  24. Randomized comparison of krypton vs. argon scatter photocoagulation for diabetic disc neovascularization: the Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy krypton argon regression neovascularization study report number 1 Ophthalmology. 1993;100:1655-64.

  25. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98:823-33.

  26. Vander JF, Duker JS, Benson WE, Brown GC, McNamara JA, Rosenstein RB. Long term stability and visual outcome after favorable initial response of proliferative diabetic retinopathy to panretinal photocoagulation. Ophthalmology. 1991;98(10):157-59.

  27. Shimura M, Yasuda K, Nakazawa T, Kano T, Ohta S, Tamai M. Quantifying alterations of macular thickness before and after panretinal photocoagulation in patients with severe diabetic retinopathy and good vision. Ophthalmology. 2003;110:2386-94.

  28. Brucker AJ, Qin H, Antoszyk AN, Beck RW, Bressler NM, Browning DJ, et al. Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol. 2009;127(2):132-40.

  29. Grading diabetic retinopathy from stereoscopic color fundus photographs- an extension of the modified Airlie House classification. ETDRS Report No. 10. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5 Suppl):786-806.

  30. Ma Y, Zhang Y, Zhao T, Jiang YR. Vascular Endothelial Growth Factor in Plasma and Vitreous Fluid of Patients with Proliferative Diabetic Retinopathy Patients after Intravitreal Injection of Bevacizumab. Am J Ophthalmol. 2012;153(2):307-313.

  31. Schmidinger G, Maar N, Bolz M, Scholda C, Schmidt-Erfurth U. Repeated intravitreal bevacizumab (Avastin) treatment of persistent new vessels in proliferative diabetic retinopathy after complete panretinal photocoagulation. Acta Ophthalmol. 2011;89:76-81.

  32. Tremolada G, Del Turco C, Lattanzio R, Maestroni S, Maestroni A, Bandello F, et al. The Role of Angiogenesis in the Development of Proliferative Diabetic Retinopathy: Impact of Intravitreal Anti-VEGF Treatment. Exp Diabetes Res. 2012.

  33. Cho WB, Moon JW, Kim HC. Intravitreal triamcinolone and bevacizumab as adjunctive treatments to panretinal photocoagulation in diabetic retinopathy. Br J Ophthalmol. 2010;94(7):858-63.

  34. 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.

  35. Arévalo JF, Sánchez JG, Lasave AF, Wu L, Maia M, Bonafonte S, et al. Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture. J Ophthalmol [Internet]. 2011 [citado 26 de diciembre de 2013]. Disponible en: http://dx.doi.org/10.1155/2011/584238

  36. Erdol H, Turk A, Akyol N, Imamoglu HI. The results of intravitreal bevacizumab injections for persistent neovascularizations in proliferative diabetic retinopathy after photocoagulation therapy. Retina. 2010;30(4):570-7.

  37. Moradian S, Ahmadieh H, Malihi M, Soheilian M, Dehghan MH, Azarmina M. Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2008;246(12):1699-705.

  38. López-López F, Gómez-Ulla F, Rodríguez-Cid MJ, Arias L. Triamcinolone and Bevacizumab as Adjunctive Therapies to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy. ISRN Ophthalmology. 2012:267-643.

  39. Wu L, Martínez Castellanos MA, Quiroz-Mercado H, Arévalo JF, Berrocal MH, Farah ME, et al. Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008;246(1):81-7.




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