Session Title: Quick Fire Free Paper 4
Session Date/Time: Sunday 14/09/2014 | 08:00-10:00
Paper Time: 09:05
Venue: Boulevard B
First Author: : Y.Alahmadawy EGYPT
Co Author(s): : M. Nabih A. Khattab R. Eltanamly
To assess the effectiveness of primary bevacizumab monotherapy versus Bevacizumab with macular laser photocoagulation in diabetic macular edema (DME) regarding visual outcome, macular thickness and number of injections required.
A 12 month, prospective, randomized study. DME patients, with good metabolic control (HBA1C ≤ 10%), without previous treatment or proliferative changes, were selected from the outpatient clinic of Kasr Al Aini hospital, Cairo University. The protocol was approved by ophthalmology ethical committee.
This study was performed on 40 eyes of 31 patients (9 patients for both eyes), with clinically significant macular oedema (focal or diffuse). In group A, 20 eyes received baseline three monthly injections of bevacizumab (1.25mg/0.05 ml), then monthly reinjection according to PRN regimen (guided by visual acuity and macular thickness), and in group B, 20 eyes received combined treatment (one injection plus laser (focal or grid) one month later, then monthly injections on need). This study compared mean best corrected visual acuity (BCVA) (logMAR), mean central macular thickness (CMT) at each visit for one year and the total number of injections needed to control the edema in both groups.
In group A, there was no significant change in mean BCVA throughout one year (p 0.165), while in group B there was significant improvement (p <0.001). Mean BCVA in group B at 12 month was 0.46 ± 0.30 (baseline: 0.73 ± 0.35) compared to 0.75 ± 0.33 in group A (baseline: 0.78 ± 0.37) (p 0.041). The mean rate of change of BCVA at 12th month was -3.7 % in group A and 14.9 % in group B. In group A 40% gained ≥ one line of BCVA compared to 65% in group B. 35 % lost ≥ 2 lines of BCVA in group A, while only 5% lost one line of BCVA. In group A there was no significant change in thickness throughout one year, with CMT 362 ± 98.0 µ at month 12 (baseline:431.0 ± 140.8 µ) (p 0.058) while in group B, there was a significant reduction of thickness 276 ± 49.0 µ at month 12 (baseline: 394.1± 101.4 µ) (p < 0.001) however final CMT weren’t significantly different (p 0.090). The mean number of injections in group A was 5.55 times while in group B was 1.4 times (p value < 0.001).
This study showed that combined treatment resulted in marked reduction of the number of injections required to control oedema. This may be of value in developing countries to minimize the financial requirements for the management of DME. Laser treatment resulted in prolonging the treatment free interval with better final visual acuity and more reduction of macular thickness.