Panretinal Photocoagulation versus Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy Treatment

Abstract

Purpose: It is to determine the visual acuity outcomes at 1 year in eyes with proliferative diabetic retinopathy using pan retinal photocoagulation compared to intravitreal Bevacizumab 1.25 mg instead of Ranbizumab to lower the cost burden. Methods: 30 eyes of 30 patients diagnosed with proliferative diabetic retinopathy and have randomized for either pan retinal laser photocoagulation or intravitreal Bevacizumab every 4 weeks based on retreatment protocol both groups can receive intravitreal bevacizumab or focal/grid laser for diabetic macular edema. Main outcome and measures: A complete exam including best corrected visual acuity changes within 52 weeks, improvement in diabetic retinopathy, central retinal thickness and cost analysis. Results: Best corrected visual acuity changed from the baseline 0.60 LogMAR in the of Bevacizumab group and 0.50 LogMAR in the PRP group, to 0.40 LogMAR in the Bevacizumab group and 0.50 LogMAR in the PRP group at week 52 (P=0.14), where central retinal thickness changes at 52 weeks from baseline -48 (-62 to -32) in the Bevacizumab group and -16 (-21 to -8) in the PRP group (p<0.001) however proportion of eyes without active or regressed neovascularization at 52 weeks are statistically not significant between two groups (p=0.43). Conclusion: Intravitreal Bevacizumab is non-inferior to pan retinal photocoagulation interim of visual acuity outcome within 52 weeks in case of proliferative diabetic retinopathy and may be more cost effective in selected cases of proliferative diabetic retinopathy with diabetic macular edema than both panretinal photocoagulation and Ranibizumab but a long term and larger studies are needed.