Combination of Intravitreal Bevacizumab and Erythropoietin Versus Intravitreal Bevacizumab Alone for Refractory Diabetic Macular Edema: A Randomized Double-Blind Clinical Trial Publisher Pubmed



Entezari M¹ ; Flavarjani ZK¹ ; Ramezani A¹ ; Nikkhah H¹ ; Karimi S² ; Moghadam HF¹ ; Daftarian N¹ ; Yaseri M³ Show Affiliations
Source: Graefe's Archive for Clinical and Experimental Ophthalmology Published:2019

Abstract

Purpose: To evaluate the effect of three intravitreal bevacizumab (IVB) injections alone or in combination with intravitreal erythropoietin (EPO) in the treatment of refractory diabetic macular edema (DME). Methods: In a randomized double-blind clinical trial, 48 eyes of 34 diabetic patients with refractory DME were enrolled. Eyes were randomly assigned to receive either 3 monthly injections of 0.05 cc (1.25 mg) IVB plus 0.05 cc (1000 unit) EPO or 0.05 cc (1.25 mg) IVB alone. Main outcome was best-corrected visual acuity (BCVA) changes and secondary outcome was central macular thickness (CMT). The patients were followed for 6 months. Results: Mean BCVA changes up to 4 and 6 months were insignificant in both groups. It changed from 0.72 ± 0.56 logMAR at baseline to 0.74 ± 0.5 (P = 0.85) and 0.71 ± 0.44 (P = 0.40) in the combination group and from 0.48 ± 0.39 logMAR to 0.47 ± 0.35 (P = 0.48) and 0.52 ± 0.33 (P = 0.69) in the IVB alone group, at 4 and 6 months, respectively. The difference of mean BCVA changes between the groups was insignificant at both 4 and 6 months (P = 0.07 and P = 0.36, respectively). Within the group changes of mean CMT were significant only in the combination group at 4 and 6 months, from 518 ± 134 μ at baseline to 472 ± 151 to 475 ± 167 μ, respectively (P = 0.01 and P = 0.05). Corresponding changes were not significant in the IVB alone group. However, the difference between the groups was not significant at all visits (P = 0.51 and P = 0.71, respectively). Conclusions: This clinical trial demonstrated that intravitreal erythropoietin had no additional effect to IVB in the treatment of refractory DME in the short term. Trial registration: Clinical trials.gov identifier: NCT03821168. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature.