Intravitreal Injection of a Rho-Kinase Inhibitor (Fasudil) Combined With Bevacizumab Versus Bevacizumab Monotherapy for Diabetic Macular Oedema: A Pilot Randomised Clinical Trial Publisher Pubmed



Ahmadieh H¹ ; Nourinia R² ; Hafezimoghadam A^{3, 4} ; Sabbaghi H⁵ ; Nakao S^{3, 4, 6} ; Zandi S^{3, 4, 7} ; Yaseri M^{1, 8} ; Tofighi Z¹ ; Akbarian S¹
Source: British Journal of Ophthalmology Published:2019

Abstract

Click here to listen to the Podcast Background/aims To compare the efficacy of combined intravitreal injection of bevacizumab and a Rho-kinase inhibitor, fasudil (intravitreal bevacizumab (IVB)/intravitreal fasudil (IVF)), with IVB alone for centre-involving diabetic macular oedema (DME). Methods In this prospective randomised clinical trial, 44 eyes with centre-involving DME were randomised into two groups. The combined group received three consecutive injections of IVB (1.25 mg) and IVF (50 μM/L) monthly, while the monotherapy group received only one IVB (1.25 mg) injection per month for 3 months. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared between the two groups at months 3 and 6. The primary outcome measure was the mean change in BCVA at month 6. Results Mean BCVA was significantly improved in both groups at month 3 (P<0.001), but it persisted up to month 6 only in the IVB/IVF group. Improvement of BCVA was greater in the IVB/IVF group at both time points (P=0.008, P<0.001). In the IVB/IVF and IVB groups, 54.5% versus 10% of the eyes gained≥15 ETDRS letters at month 6 (P=0.026). Between months 3 and 6, mean BCVA significantly decreased by 5±7 ETDRS letters in the IVB group (P=0.002), while no significant deterioration was observed in the IVB/IVF group. Corresponding with the BCVA changes, CMT was significantly reduced in both groups at month 3 (p=0.006, p<0.001) but this reduction sustained only in the IVB/IVF group up to month 6 (p<0.001). Conclusion Adjunctive intravitreal injection of a Rho-kinase inhibitor may enhance and prolong the therapeutic effects of anti-vascular endothelial growth factor drugs for centre- involving DME. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.