Results after combined treatment of intravitreous bevacizumab with laser photocoagulation in diabetic macular edema
Keywords:
macular edema; intravitreous bevacizumab with laser photocoagulation., macular edema, intravitreous bevacizumab, laser photocoagulationAbstract
Introduction: the proliferative diabetic retinopathy and the diabetic macular edema clinically significative can provoke visual loss. At present there are multiple alternatives of treatment.
Aim: To evaluate the results of combined treatment of intravitreous bevacizumab with laser photocoagulation in patients with clinically significant diabetic macular edema.
Method: A prospective longitudinal case series study was performed in 36 patients, who were treated in the medical office for vitreous retina at Hermanos Ameijeiras Clinical-Surgical Hospital between 2014 and 2015. Between the third and fourth weeks after the combined treatment of intravitreous bevacizumab, laser photocoagulation was performed on the grid. The following variables were evaluated: age, sex, best corrected visual acuity, macular thickness measured by optical coherence tomography, glycosylated hemoglobin, and time course of diabetes mellitus. The improvement criteria were: increase of one or more lines of visual acuity better corrected with respect to baseline, and macular thickness decrease of 50 ? or over.
Results: The variables influencing or separately associated to macular thickness were showed to be: absence of non-proliferative diabetic retinopathy, evolution time, and glycosylated hemoglobin. The regression coefficients were significantly different from 0 (p<0.05) R2=0.425 for the best corrected visual acuity.
Conclusions: Combined treatment of intravitreous bevacizumab with laser photocoagulation in diabetic macular edema was satisfactory in the series studied, in terms of visual acuity improvement and macular thickness decrease. In addition, we demonstrated the association between visual results and the absence of non-proliferative diabetic retinopathy, shorter evolution time and better metabolic control.
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References
World Health Organization. Global report on diabetes 2016 [citado 13 ene 2015]. Disponible en: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf
Varma R, Bressler NM, Doan QV, Gleeson M, Danese M, Bower JK, et al. Prevalence and risk factors for diabetic macular edema in the United States. JAMA Ophthalmol. 2014:1334-40.
Hee M, Puliafito C, Duker J. Topography of diabetic macular edema with an optical coherence tomography. Ophthalmology. 1998;105:360-70.
Pires I, Bernardes RC, Lobo CL, Soares MA, Cunha-Vaz JG. Retinal thickness in eyes with mild nonproliferative retinopathy in patients with type 2 diabetes mellitus: comparison of measurements obtained by retinal thickness analysis and optical coherence tomography. Arch Ophthalmol. 2002; 120:1301-6. PubMed PMID:12365908
Schmid KE, Neumaier-Ammerer B, Stolba U, Binder S. Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c). Graefes Arch Clin Exp Ophthalmol. 2006;244:1446-52.
Murphy R. Therapeutic triangulation: the treatment revolution. Retin Phys. 2012 [citado 29 ene 2015]. Disponible en: http://www.retinalphysician.com/articleviewer.aspx?articleID=106954
Nguyen QD, Brown DM, Marcos DM, Boyer DS, Patel S, FeinerL, et al. Ranibizumab for diabetic macular edema: result from 2 phase III Randomized trial: RISE and RISE. Ophthalmology. 2012;11:543-53.
Patel AK, Gentile R. Surgical treatment of diabetic macular edema. Retin Phys. 2013;10:16-23.
Solaiman KA, Diab MM, Dabour SA. Repeated intravitreal bevacizumab injection with and without macular grid photocoagulation for treatment of diffuse diabetic macular edema. Retina. 2013;33(8):1623-29.
Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of prediabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005-2006. Diabetes Care. 2009;32:342-7.
Diabetic Retinopathy Clinical Research Network Writing Committee. Bressler SB , Edwards AR , Chalam KV , Bressler NM , Glassman AR , et al. Reproducibility of spectral-domain optical coherence tomography retinal thickness measurements and conversion to equivalent time-domain metrics in diabetic macular edema. JAMA Ophthalmol. 2014;132:1113-22.
Schmid KE, Neumaier-Ammerer B, Stolba U, Binder S. Effect of grid laser photocoagulation in diffuse diabetic macular edema in correlation to glycosylated haemoglobin (HbA1c). Graefes Arch Clin Exp Ophthalmol. 2006;244:1446-52.
Yeung L, Sun Ch, Ku WCh, Chuang LH, Chen CH, Huang BY, et al. Associations between chronic glycosylated haemoglobin (HbA1c) level and macular volume in diabetes patients without macular oedema. Acta Ophthalmol [Internet]. 2010 [cited 2015 May 20]:88:753–8 . Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1755-3768.2009.01711.x/abstract
Danaei G, Finucane MM, Lu Y, Singh GM, C owan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2 7 million participants. Lancet. 2011 [cited 2012 Ago 28];378:31-40. Disponible en: http://www.sciencedirect.com/science/article/pii/S014067361160679X
Selvin E, Parrinello CM. Age-related differences in glycaemic control in diabetes. Diabetologia. 2013;56(12):2549-51.
Yannuzzi NA, Klufas MA, Quach L, Beatty LM, Kaminsky SM, Crystal RG, et al. Evaluation of compounded bevacizumab prepared for intravitreal injection. JAMA Ophthalmol. 2015;133:32-9.
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