Author(s): Ashok Madan1, Minal Vyawahare2, Vandana Iyer3, Vaibhav Patil4
Diabetic retinopathy is most common ocular complication of diabetes mellitus. Retinal neovascularisation is important cause of vision loss in diabetic patients. Panretinal photocoagulation has been standard treatment for proliferative diabetic retinopathy for several decades. However, intravitreal anti-VEGF now becoming popular in treatment of proliferative diabetic retinopathy and macular oedema.
The aim of the study is to compare the effects of Panretinal Photocoagulation (PRP) with PRP plus intravitreal injection of ranibizumab in patients with high-risk Proliferative Diabetic Retinopathy (PDR).
MATERIALS AND METHODS
It is hospital-based prospective longitudinal interventional study included patients with high-risk PDR randomly assigned to receive PRP (PRP group) or PRP plus IVR (PRP plus group). Seventy eyes of 36 patients were part of this study. PRP was administered in two sessions (weeks 0 and 2) and panretinal photocoagulation done 7 days after intravitreal injection in PRP plus group. In follow up period, ophthalmic evaluations including Best-Corrected Visual Acuity (BCVA), fluorescein angiography to measure area of Fluorescein Leakage (FLA) and Optical Coherence Tomography (OCT) for the assessment of Central Subfield Macular Thickness (CSMT) were performed at baseline and at weeks 12, 16 and 24. Group analysis at baseline were performed with ANOVA and t-test, while effect of treatment compared by Wilcoxon rank sum test.
At baseline, there was no significant difference between two groups in BCVA, CSMT and FLA. Best-corrected visual acuity worsening was observed at all study visits after treatment in the PRP group (p <0.05), while significant increase in BCVA changes were observed in the PRP plus group. A significant CSMT increase was observed in the PRP group at all study visits, while a significant decrease in CSMT was observed in the PRP plus group at weeks 12, 16 and 24.
Intravitreal ranibizumab with PRP was associated with greater improvement of visual acuity, larger reduction of fluorescence leakage and greater resolution of macular oedema when compared with PRP alone in eyes with high-risk PDR.