Laser Photocoagulation Combained with Intravitreal Bevacizumab Injection in Diabetic Retinopathy with Macular Edema

Anar Toishubai¹, Baasankhuu Jamiyanjav², Uranchimeg Davaatseren², Bulgan Tuvaan², Chimgee Chuluunkhuu³

¹The Department of Ophthalmology, Shastin Central Hospital, Ulaanbaatar, Mongolia
²Health and Science Univercity of Mongolia, Ulaanbaatar, Mongolia
³Sight Eye Clinic, Ulaanbaatar, Mongolia

Purpose: To evaluate therapeutic effects of a combination treatment of intravitreal injection of bevacizumab and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR).

Methods: Visual acuity test, fundoscopy, color fundus photography, and fluorescein angiography were taken in 24 patients (24 eyes) of macular edema and PDR. A combination of intravitreal injection of bevacizumab and PRP was performed in 12 patients (12 eyes) and combination of focal or grid laser photocoagulation and PRP in the remaining 12 eyes. The postoperative outcomes were compaired between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography at 2 weeks, 1, 2, and 3 months.

Results: Average BCVA (log MAR) significantly improved from preoperative 0.56±0.20 to 0.43±0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of intravitreal injection of bevacizumab and PRP in 12 eyes (P=0.007).

Conclusions: A combination of intravitreal injection of bevacizumab and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, intravitreal injection of bevacizumab might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.