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Contrast sensitivity evaluation in high risk proliferative diabetic retinopathy treated with panretinal photocoagulation associated or not with intravitreal bevacizumab injections: a randomised clinical trial
  1. Rony Carlos Preti1,
  2. Lisa Mariel Vasquez Ramirez1,
  3. Mario Luiz Ribeiro Monteiro1,
  4. Mario Kehdi Carra2,
  5. David E Pelayes3,4,
  6. Walter Yukihiko Takahashi1
  1. 1Department of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
  2. 2Department of Endocrinology, University of São Paulo Medical School, São Paulo, Brazil
  3. 3Area of Ophthalmology, Buenos Aires University, Buenos Aires, Argentina
  4. 4Centre for Applied Research and High Complexity in Ophthalmology, Maimónides University, Buenos Aires, Argentina 
  1. Correspondence to Dr R C Preti, Division of Ophthalmology, University of São Paulo Medical School, Av Ramalho Ortigão, 269 apartamento 54—Vila Gumercindo, São Paulo 04130010, Brazil; preti{at}usp.br

Abstract

Purpose To compare the effect on contrast sensitivity (CS) measurements of panretinal photocoagulation (PRP) associated with intravitreal bevacizumab (IVB) injections versus PRP alone in high risk proliferative diabetic retinopathy (HR-PDR).

Design Prospective, randomised, masked, controlled trial.

Participants 42 patients with HR-PDR with visual acuity ≥20/200.

Methods Eyes were randomised to one of two groups: one underwent PRP and IVB injections (study group) and the other PRP alone (control group). PRP was performed three times during the study and IVB injection was administered twice.

Main outcome measures Mean change in CS threshold scores between and within groups, from baseline to 6 months.

Results Seven patients presented with vitreous haemorrhage and were removed from the study. Mean results for CS threshold (at 1.5, 3, 6, 12 and 18 cycles per degree (cpd) frequencies) for patients with and without diabetic macular oedema showed no significant differences (p>0.05 for all comparisons) between the two groups. In 35 eyes in the control group, compared with baseline values, there was significant worsening (p<0.05) of CS at 1.5, 12 and 18 cpd after 1 month, at 12 cpd after 3 months, and at 6 and 12 cpd after 6 months. In the study group, there was significant improvement in CS at 3 cpd, 3 months after treatment.

Conclusions In eyes with HR-PDR, PRP treatment is associated with deterioration of CS while adjuvant use of bevacizumab prevents such deterioration. CS evaluation seems to support the adjuvant use of bevacizumab when using PRP for the treatment of HR-PDR.

ClinicalTrials.gov Identifier NCT 01389505.

  • Angiogenesis
  • Retina
  • Treatment Lasers
  • Visual perception
  • Treatment Medical

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