Bevacizumab Combined With Triamcinolone For The Treatment Of Severe Proliferative Diabetic Retinopathy

Purpose: To evaluate the safety and efficacy of triamcinolone acetonide(TA) and Bevacizumab as adjunctive treatments of pars plana vitrectomy (PPV) for severe proliferative diabetic vitreoretinopathy (PDR).Methods:we studied 29 patients (34 eyes) with severe PDR assigned to one of three study arms: the TA group, patients who received 2 mg of intravitreal triamcinolone at the end of PPV; the intravitreal bevacizumab (IVB) group, patients who received 1.25 mg of intravitreal bevacizumab three to five days before PPV and received 2 mg triamcinolone, the same to TA group; and the contral group, patients who underwent direct PPV. PPV and removal of fibrovascular tissue combined with endolaser peripheral photocoagulation (PRP) was the primary surgical technique.Surgical time (minutes), intraoperative bleeding, intraoperative retinal tears and fibrovascular membrane residual were the main outcome measures during operation. Best-corrected visual acuity (BCVA), fundus photography (FFA), optical coherence tomography (OCT), intraocular Pressure (IOP) and intervention therapies for complications were performed at months 1, 3, 6 and at 10days.Results:1.The rapid dramatic regression and subsequent fibrosis of retinal neovascularization achieved after IVB, make mean surgical time shorter and reduced bleeding, intraoperative retinal tears and fibrovascular membrane residual significantly. no local complications or systemic adverse effects were observed After IVB.2. Mean post-operative BCVA improved significantly in three groups, and significantly better in TA and IVB group with respect to the control. Central macular thickness (CMT) improved significantly compared with the TA and control group at 10 days, and CMT was better in group TA and IVB than control at 1,3 month, but the same to each other at 6 month. During the study, no significant increase in IOP was observed, and no significant cataract happened.3. Fluid leakage, ischemic areas and clinical significant macular edema (CSME) were reduced in group TA and IVB. Furthermore, photocoagulation and intravitreal injection were fewer than contral group.Conclusions:1. IVB administered prior to vitrectomy reduced active neovascularization rapidly, thus facilitating PPV.2. Intravitreal triamcinolone at the end of PPV was associated with short-term improved BCVA and macular edema. The synergistic effect of TA and Bevacizumab was observed.3. TA and IVB as adjunctive treatments of PPV for severe PDR were effective and safe.