Bevacizumab-Augmented Retinal Laser Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Double-Masked Clinical Trial

Abstract

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.

Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications

“…Antiangiogenic VEGF inhibitors, including bevacizumab and pegaptanib, have been used in the treatment of proliferative DR in small trials. In the short term, the proportion of anti-VEGF-treated patients with complete regression of retinal neovascularization was significantly higher than in the control groups [124,125]. Polymorphism in the retinoid-X receptor (RXR) gamma gene has also been associated with DR (OR = 2.388; 95% confidence interval = 1.17-4.875) in Asians with T2D [126].…”

A review of anti-VEGF agents for proliferative diabetic retinopathy

“…Likewise, Schmidinger et al 41 reported that 62% (8 of 13) of eyes required retreatment with bevacizumab at a 3-month follow-up visit because of the reappearance of new vessels. In another study, Mishahi et al 28 showed complete regression in 87.5% of Avastin-injected eyes and 25% of sham group at week 6 of follow-up (Po0.005). 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 ¼ 1.000).…”

“…24 Anti-VEGF treatment and safety Dosage and frequency of anti-VEGF treatment in PDR cases The optimal dose and dosing sequence for bevacizumab remains unclear. Most studies have used a dose of 1.25 mg. [25][26][27][28][29] Arevalo and Garcia-Amaris 30 used dosages of 1.25 mg (20.5%) and 2.5 mg (79.5%) bevacizumab, depending on the discretion of the treating clinician, and noted that the 2.5-mg dose was more effective in inducing complete regression of neovascularization relative to the 1.25-mg dose in the treatment of naive eyes.…”

Antiangiogenic Therapy for Ischemic Retinopathies

“…At 12 weeks, 14 out of 15 patients showed recurrent leakage but to a lesser extent than at baseline . Similar studies have reported similar short term efficacy of bevacizumab in inducing regression of retinal neovascularization (Mirshahi et al 2008;Tonello et al 2008;Erdol et al 2010). Currently, the Diabetic Retinopathy Clinical Research Network (DRCR.net) is conducting two trials: one to study the efficacy of ranibizumab in cases of vitreous hemorrhage caused by PDR, and another to assess the efficacy of adjunctive use of ranibizumab compared to triamcinolone with laser treatment in PDR.…”