Intravitreal triamcinolone and bevacizumab as adjunctive treatments to panretinal photocoagulation in diabetic retinopathy.

Abstract

To evaluate efficacy of intravitreal triamcinolone (IVTA) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP). In 91 eyes of 76 patients (clinically significant macular oedema (CSME) 46 eyes; no CSME 45 eyes) with severe diabetic retinopathy, PRP with IVTA (IVTA group, 30 eyes) or PRP with IVB (IVB group, 31 eyes) or PRP only (PRP group, 30 eyes) was performed. Primary outcome measures were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) at 1 and 3 months. Secondary outcome measures were proportion of visual gain or loss, and decreased or increased CMT. There was significant worsening in BCVA from 0.26 to 0.29 at 1 and 3 months (p=0.031) in the PRP group. In eyes with CSME, there was significant improvement of BCVA from 0.33 to 0.27 at 1 and 3 months (p=0.012) in IVTA group. In eyes without CSME, PRP group showed significant worsening in BCVA from 0.18 to 0.26 at 1 month (p=0.008) and 0.27 at 3 months (p=0.005). There was significant improvement in CMT in IVTA and IVB groups: in eyes without CSME, there was significant increase in CMT from 209.75 to 259.00 microm at 1 month (p=0.023) and to 276.14 microm at 3 months (p=0.011) in the PRP group; in eyes with CSME, the proportion of eyes with visual gain and decreased CMT was significantly higher in the IVTA group (75% and 100%, respectively) than in the IVB group (37.5% and 62.5%, respectively). IVTA and IVB may be effective adjunctive treatments to PRP, minimising the risk of PRP-induced macular oedema and visual loss.