Perfusion Recovery After Panretinal Photocoagulation Combining Bevacizumab Analyzed with Optical Coherence Tomography Angiography in Diabetic Retinopathy


Perfusion Recovery After Panretinal Photocoagulation Combining Bevacizumab Analyzed with Optical Coherence Tomography Angiography in Diabetic Retinopathy by Eoi Jong Seo



Panretinal photocoagulation (PRP) currently is a gold-standard treatment for advanced diabetic retinopathy. It is believed that PRP lowers intraocular vascular endothelial growth factor (VEGF) secretion from non-perfused retina and arrests development of neovascularization. Because of a chance to get a consequent macular edema, bevacizumab is often injected before or after PRP treatment to prevent it in clinical practice. In recent reports, anti-VEGF injectio n also seems to have some roles on perfusion improvement and neovascularization suppression on diabetic retinopathy. With an introduction of optical coherence tomography angiography (OCTA), we tried to find the effect of PRP combining bevacizumab, which can effectively reduce intraocular VEGF level, on retinal perfusion in diabetic retinopathy.


We retrospectively reviewed medical records and optical coherence tomography angiography (OCTA) results of the patients who received panretinal photocoagulation combining bevacizumab injection due to diabetic retinopathy. PRP was performed in severe non-proliferative or proliferative diabetic retinopathy in an average of 2000 spots per eye with PASCAL device (Optimedica, Topcon). Intravitreal bevacizumab injection was performed before and after PRP if clinically indicated. OCTA (Angiovue, Optovue) was taken before and after treatment. Macular superficial capillary plexus (SCP) density and deep capillary plexus (DCP) density and peripapillary capillary (PPC) density were collected and compared. Each density was analyzed by OCTA device embedded software.


36 eyes of 20 diabetic patients were analyzed. SCP, DCP, PPC densities were 43.8 ± 4.2, 49.8 ± 3.9, 58.5 ± 4.7, respectively. It was revealed that every three density is positively correlated to one another in Pearson correlation analysis (P value of SCP-DCP, SCP-PPC, DCP-PPC: <0.001, 0.001, <0.001, respectively). Post-treatment OCTA examination was done in 17 eyes. After treatment, SCP density was found to be significantly increased from 42.8 ± 4.2 to 44.4 ± 3.0 (p=0.025, paired t-test). DCP and PPC density also showed an increasing tendency. Particularly in eyes with poor initial SCP density, both SCP (39.9 ± 2.4 to 42.6 ± 2.3) and DCP (47.7 ± 4.6 to 50.2 ± 3.1) showed a significant increase after treatment (p=0.011 and 0.017 respectively, paired t-test). Central subfield thickness before and after treatment was 249.8 ± 34.0㎛ and 256.5 ± 33.7㎛, respectively.


Using OCTA, we found PRP combining bevacizumab would recover macular capillary perfusion in advanced diabetic retinopathy. This change was prominent in eyes already experience considerable capillary loss. This result supports the recent state that lowering intraocular VEGF can rescue viable capillary damage of diabetic retinopathy. We also revealed a positive correlation between macular and peripapillary capillary density. Some patients who have severe macular degeneration or edema have difficulties in measuring macular capillary density. This relationship would be helpful to such patients by measuring peripapillary capillary density instead of macular density.



Eoi Jong Seo
Seoul, South Korea
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