Evaluation of efficacy of combined intravitreal bevacizumab and grid laser treatment in diabetic macular edema

Abstract

Objective: To evaluate the efficacy of combined treatment of intravitreal bevacizumab injection followed by grid laser photocoagulation in patients with diabetic macular edema

Methods: Patients with diabetic macular edema received single dose intravitreal bevacizumab injection and followed by grid laser photocoagulation treatment four weeks later in the retrospectively conducted study. All eyes had underwent a complete ophthalmic examination including optical coherence tomography at baseline and at first and third month after laser treatment. The changes between outcome and baseline measurements in central macular thickness, macular cube volume and best-corrected visual acuity were observed. The changes in intraocular pressure and any reported complication were also evaluated.

Results: After the combined therapy the reduction in the mean of central macular thickness was 96.91 μm (24.94%) with a corresponding improvement in best-corrected visual acuity. The reduction in the mean of central macular thickness and the improvement in the mean of best-corrected visual acuity were statistically significant (p ˂ 0.05). There was no significant changes in the mean of IOP (p = 0.95). No complication related to the intravitreal injection or laser photocoagulation was reported in the treated eyes.

Conclusion: Combined therapy with intravitreal bevacizumab injection and sequential grid laser photocoagulation appeared to be effective in reducing central macular thickness and cube volume and improving visual acuity. A combination of intravitreal bevacizumab injection and sequential grid laser photocoagulation could be used as an initial treatment of diabetic macular edema. J Clin Exp Invest 2015; 6 (4): 351-356

Key words: Bevacizumab, diabetic macular edema, grid laser photocoagulation

Keywords

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Diyabetik maküler ödemde kombine intravitreal bevacizumab ve grid lazer tedavisi etkinliğinin değerlendirilmesi

Öz

Amaç: Kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu tedavisinin diyabetik maküler ödemde etkinliğini retrospektif olarak araştırmak. Yöntemler: Retrospektif olarak yapılan çalışmada, diyabetik maküler ödemi olan hastalara tek doz intravitreal bevacizumab enjeksiyonu uygulandı ve dört hafta sonra da grid lazer fotokoagülasyonu yapıldı. Tedavi öncesi ve lazer tedavisi sonrası 1. ve 3. aylarda, tüm gözlerin optik koherens tomografisi çekildi ve detaylı oküler muayeneleri yapıldı. Çalışmada, santral maküler kalınlık, maküler hacim ve düzeltilmiş en iyi görme keskinliği parametrelerinin tedavi öncesi ve sonrasındaki değişimleri gözlemlendi. Göz içi basıncındaki değişimler ve oluşabilecek komplikasyonlar da değerlendirilmeye tabi tutuldu. Bulgular: Kombine tedavi sonrası, görme keskinliğinde iyileşme sağlandı ve santral maküler kalınlık ortalamasında 96,91 (%24,94) mikronluk bir azalma meydana geldi. Kombine tedavi sonrası santral maküler kalınlık, maküler hacim ve düzeltilmiş en iyi görme keskinliği ortalamalarındaki değişiklikler istatistiksel olarak anlamlı bulundu (p < 0,05). Göz içi basıncı ortalamasında anlamlı bir değişiklik saptanmadı (p = 0,95). İntravitreal enjeksiyon veya lazer fotokoagülasyona bağlı komplikasyon gelişmedi. Sonuç: Kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu tedavisinin diyabetik maküler ödemli hastalarda santral maküler kalınlık ve maküla hacminde azalma, görme keskinliğinde iyileşme sağladığı gözlemlendi. Dolayısıyla kombine intravitreal bevacizumab enjeksiyonu ve grid lazer fotokoagülasyonu diyabetik maküler ödemde ilk tedavi seçeneği olarak kullanılabilir.

Anahtar Kelimeler

• Bevacizumab, diyabetik maküler ödem, grid lazer fotokoagülasyon

Kaynakça

1. Habib SL, Rojna M. Diabetes and risk of cancer. ISRN Oncol 2013;2013:583786.
2. Williams R, Airey M, Baxter H, et al. Epidemiology of diabetic retinopathy and macular oedema: a systematic review. Eye(Lond) 2004;18:963-983.
3. Gupta R, Kumar P. Global diabetes landscape-type 2 diabetes mellitus in South Asia: epidemiology, risk factors, and control. Insulin 2008;3:78-94.
4. Aiello LP, Gardner TW, King GL, et al. Diabetic retinopathy.
5. Diabetes Care 1998;21:143–156
6. Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol 2007;14:179–183.
7. Soheilian M, Garfami KH, Ramezani A, Yaseri M, Peyman GA. Two-year results of a randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus laser in diabetic macular edema.
8. Retina 2012;32:314–321.

9. Lang GE. Diabetic macular edema. Int J Ophthalmol 012;227:21–29
10. Aiello LP, Gardner TW, King GL, et al. Diabetic retinopathy.
11. Diabetes Care 1998;21:143–156.
12. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin epidemiologic study of diabetic retinopathy.XV. The long-term incidence of macular edema.Ophthalmology 1995;102:7–16.
13. Klein R, Knudtson MD, Lee KE, Gangnon R, Klein BE.The wisconsin epidemiologic study of diabetic retinopathy XXIII: the twenty-five-year incidence of macular edema in persons with type 1 diabetes. Ophthalmology 2009;116:497–503.
14. Klein R. The Diabetes Control and Complications Trial.
15. In: Kertes C, ed. Clinical Trials in Ophthalmology: A Summary and Practice Guide 1998:49-70.
16. Ozdek SC, Erdinç MA, Gürelik G, et al. Optical coherence
17. tomographic assessment of diabetic macular edema; comparison with fluorescein angiographic and clinical findings. Opthalmologica 2005;219:86–92.
18. Sohn HJ, Han DH, Kim IT, et al. Changes in aqueous
19. concentrations of various cytokines after intravitreal triamcinolone versus bevacizumab for diabetic macular edema. Am J Ophthalmol 2011;152:686-694.
20. Early Treatment Diabetic Retinopathy Study Research Group. Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number
21. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 1987;94:761-774.
22. Klein R, Klein BE, Moss SE. Visual impairment in diabetes.
23. Ophthalmology 1984;91:1–9.
24. Stefanini FR, Arevalo JF, Maia M. Bevacizumab for the management of diabetic macular edema. World J Diabetes 2013;4:19-26.
25. Ogino K, Tsujikawa A, Murakami T, et al. Grid photocoagulation
26. combined with intravitreal bevacizumab for recurrent macular edema associated with retinal vein occlusion. Clin Ophthalmol 2011;5:1031-1036.
27. Lee SJ, Kim ET, Moon YS. Intravitreal bevacizumab alone versus combined with macular photocoagulation in diabetic macular edema. Korean J Ophthalmol 2011;25:299-304.
28. Arevalo JF, Lasave AF, Wu L, et al. Pan-American Collaborative Retina Study Group (PACORES). Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema: results of
29. the Pan-american Collaborative Retina Study Group at 24 months. Retina 2013;33:403-413.
30. Elman MJ, Aiello LP, Beck RW, et al. Diabetic Retinopathy
31. Clinical Research Network. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 2010;117:1064-1077.
32. Barteselli G, Kozak I, El-Emam S, et al. 12-month results
33. of the standardized combination therapy for diabetic macular edema: intravitreal bevacizumab andnavigated retinal photocoagulation. Br J Ophthalmol 2014;98:1036-1041.