34748
document
Bevacizumab-augmented retinal laser photocoagulation in proliferative diabetic retinopathy : a randomized double-masked clinical trial . PURPOSE To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy . METHODS A prospective , fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics . All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol . Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab ( Genentech Inc. , San Francisco , CA ) on the first session of their laser treatments . Fluorescein angiography was performed at baseline and at weeks 6 and 16 , and proliferative diabetic retinopathy regression was evaluated in a masked fashion . RESULTS The median age was 52 years ( range : 39-68 ) and 30 % of the participants were male . All patients were followed for 16 weeks . A total of 87.5 % of Avastin-injected eyes and 25 % of sham group showed complete regression at week 6 of follow-up ( p < 0.005 ) . However , at week 16 , PDR recurred in a sizable number of the Avastin-treated eyes , and the complete regression rate in the two groups became identical ( 25 % ; p=1.000 ) ; partial regression rates were 70 % vs 65 % . In the subgroup of Avastin-treated eyes , multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence ( p=0.033 ) . CONCLUSIONS Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived , as many of the eyes showed rapid recurrence . Alternative dosing ( multiple and/or periodic intravitreal Avastin injections ) is recommended for further evaluation .
34749
Intervention_Pharmacological
Bevacizumab-augmented
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Intervention_Physical
retinal laser photocoagulation
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Intervention_Pharmacological
intravitreal bevacizumab injection
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Intervention_Physical
standard laser treatment
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Intervention_Physical
laser treatment
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Intervention_Pharmacological
1.25 mg intravitreal bevacizumab
34755
Intervention_Physical
Fluorescein angiography
34756
Intervention_Pharmacological
Avastin-treated
34757
Intervention_Pharmacological
bevacizumab
34758
Intervention_Pharmacological
Avastin
34759
Outcome_Physical
complete regression
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Outcome_Physical
PDR
34761
Outcome_Physical
complete regression rate
34762
Outcome_Physical
proliferative diabetic retinopathy recurrence
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Outcome_Physical
rapid recurrence