Panretinal photocoagulation combined with intravitreal bevacizumab in high-risk proliferative diabetic retinopathy

To evaluate the efficacy and safety of intravitreal bevacizumab as an adjunctive treatment to panretinal photocoagulation (PRP) for high-risk proliferative diabetic retinopathy with or without clinically significant macular edema (CSME).

In forty-one eyes with high-risk proliferative diabetic retinopathy, intravitreal bevacizumab (1.25 mg/0.05 mL) before PRP (Plus group) or PRP alone (PRP group) was performed. Primary outcome measures were changes in best-corrected visual acuity and central macular thickness (CMT). Secondary outcome measures were the proportion of visual loss >/=0.1 logMAR, increase in CMT >/=50 mum, and eyes with development of vitreous hemorrhage.

Best-corrected visual acuity was significantly worse at 3 months (P = 0.041) in the PRP group, whereas in the plus group, there was no significant change. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.012, 0.008) in the Plus group, whereas in the PRP group, there was no significant change. In eyes with CSME, there was no significant change in best-corrected visual acuity in both groups. Central macular thickness decreased significantly at 1 month and 3 months (P = 0.003, 0.001) in the Plus group, whereas in the PRP group, there was no significant change. In eyes without CSME, best-corrected visual acuity was significantly worse at 1 month and 3 months (P = 0.047, 0.011) in the PRP group, whereas in the Plus group, there was no significant change. Central macular thickness was significantly worse at 1 month and 3 months (P = 0.004, 0.016) in the PRP group, whereas in the Plus group, there was no significant change. In eyes without CSME, the proportion of eyes with visual loss >/=0.1 logMAR at 1 month was significantly higher in the PRP group than in the Plus group (P = 0.020). The proportion of eyes with development of vitreous hemorrhage was significantly lower in the Plus group than in the PRP group (P = 0.023).

Intravitreal bevacizumab before PRP can be an effective adjunctive treatment to PRP in the treatment of high-risk proliferative diabetic retinopathy, especially if there is not CSME.