Diabetic Retinopathy & Medical Retina - aioseducation
Diabetic Retinopathy & Medical Retina - aioseducation
Diabetic Retinopathy & Medical Retina - aioseducation
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70th AIOC Proceedings, Cochin 2012<br />
Baseline Evaluation<br />
A detailed ophthalmic evaluation including BCVA, slit lamp biomicroscopy,<br />
applanation tonometry and dilated fundus examination was carried out. All<br />
patients underwent fundus photography, digital fluorescein angiogram and<br />
optical coherence tomography (OCT) scan. <strong>Retina</strong>l thickness was measured in a<br />
circle (3.5 mm diameter) centred on the fovea. (CRT) was recorded and considered<br />
for statistical analysis. Eligible eyes were grouped into three: IVB group (Group<br />
1) eyes receiving IVB injection alone; IVB/IVTA group (Group 2) eyes receiving<br />
IVB injection plus IVTA, and Laser group (Group 3) undergoing laser alone.<br />
Surgical Technique<br />
Under sterile conditions, under topical anesthesia and following application<br />
of a drape and insertion of a lid speculum, intravitreal injections 0.05ml<br />
(1.25 mg of Bevacizumab) were undertaken with a 30 guage needle through<br />
the superotemporal quadrant. Patency of the central retinal artery was<br />
determined by indirect ophthalmoscopy. The IOP was checked 30 minutes<br />
after the injection and if the pressure was increased (≥30mm Hg) appropriate<br />
treatment was commenced. After the injection, topical antibiotic drops and anti<br />
inflammatory drops were given 4 times daily for 1 week. In the combination<br />
group all patients received both bevacizumab and triamcinolone injected<br />
separately under aseptic precautions.<br />
In the laser treated group, standard focal or modified grid laser was performed.<br />
Modified ETDRS laser photocoagulation comprised 50-100 µm spot size, laser<br />
applied only greater than 500 microns from the edge of the FAZ, with focal<br />
treatment aiming to cause mild blanching of the retinal pigment epithelium<br />
and not darkening/ whitening of microaneurysms. Areas of diffuse leakage<br />
or non perfusion were similarly treated in a grid pattern.<br />
Patients who received injections were examined at 1 and 7 days after injection<br />
for anterior chamber reaction and intraocular pressure measurement.<br />
Complete ocular examination and optical coherence tomography were<br />
performed again at 6, 12, 24 and 36 weeks. Digital fluorescein angiography<br />
was repeated as needed.<br />
The protocol for retreatment after the initial loading dose for all 3 groups was based<br />
on the response to treatment and was repeated if CRT>300 micron. The number<br />
of repeat injection was 4 in the Bevacizumab gp and 2 in the combined group.<br />
Outcome Measures<br />
Primary outcome measure was change in BCVA at week 24, 12 months and<br />
24 months from baseline and also whether this visual gain was preserved or<br />
improved at 24 months. Secondary outcomes were CRT changes by optical<br />
coherence tomography and injection related complications.<br />
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