Diabetic Retinopathy & Medical Retina - aioseducation

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