Bevacizumab For Diabetic Macular Edema Research Articles

Short-Term Effects of Adding Topical Ketorolac to Intravitreal Bevacizumab in Diabetic Macular Edema: A Crossover Randomized Clinical Trial.

To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME). In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT). Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was -0.09 0.47 logMAR in the periods of receiving ketorolac and -0.03 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were -13.1 170.1 and +11.7 157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012). This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period.

Intravitreal Injection of Bevacizumab in Diabetic Macular Edema: a Literature Review

Intravitreal Injection of Bevacizumab in Diabetic Macular Edema: a Literature Review

A Comparison of Visual Outcomes Between Patients Treated with Intravitreal Ranibizumab and Bevacizumab for Diabetic Macula Edema in A Real World Setting in Sub-Saharan Africa

Aims and Objectives: To report a comparison of visual outcomes between patients treated with intravitreal ranibizumab and bevacizumab for diabetic macula oedema (DME) in a real-world setting in sub-Saharan Africa. Methods: A retrospective review of cases files of patients who were treated with either intravitreal ranibizumab or bevacizumab for diabetic macular edema in Eye Foundation Hospital Ikeja, Lagos, Nigeria between January 2018, and January 2019. Results: A total of 508 injections were received by 138 eyes of 115 patients within the study year and diabetic macular edema accounted for 36 eyes, (26.1%) of the total eyes that received either intravitreal Ranibizumab or Bevacizumab. There were 18 males (50%) and 18 (50%) females. Overall, the mean baseline pre injection BCVA was 0.32 ± 0.24 (range:0.05-1.0). One hundred and forty-three total injections of either Bevacizumab or Ranibizumab were received by the 36 eyes of DME participants. Fifteen eyes (41.7%) received Bevacizumab while 21 eyes (58.3%) received Ranibizumab injections. At 4 months a larger percentage of eyes (47.6%) that received Ranibizumab had better visual acuities compared to (13.3%) eyes that received Bevacizumab. At 6 months, more of the eyes that received Ranibizumab had better visual acuities (26.7%) compared to 23.8% that received Bevacizumab. At 9 months, more of the eyes that received Ranibizumab had better visual acuities (33.3%) compared to (19%) those that received Bevacizumab. However, these differences were not statistically significant. Compliance to treatment regime was poor, only 7 eyes of the 36 eyes (19.4%) were compliant, 5 eyes (33.3%) form Bevacizumab group and 2 eyes (9.5%) from the Ranibizumab group. Conclusion: Despite poor compliance, improvements in best corrected visual acuities was achieved and maintained with the use of either intravitreal bevacizumab or ranibizumab for diabetic macula edema in a real life setting in sub-Saharan Africa. Neither bevacizumab nor ranibizumab showed statistically significant superiority.

Association of White Blood Cell Counts, Leukocyte Ratios, and Serum Uric Acid with Clinical Outcome of Intravitreal Bevacizumab in Diabetic Macular Edema.

PurposeTo investigate the role of serum uric acid and leukocyte counts and ratios as predictors of clinical outcomes of intravitreal bevacizumab in diabetic macular edema.MethodsIn this prospective study, the patients were treated with three monthly intravitreal bevacizumab. The correlation of serum uric acid and immune cell indices with the changes of best-corrected visual acuity and central macular thickness at the end of month 3 were evaluated through univariate and multivariate linear regression analysis.ResultsA total of 80 eyes from 80 diabetic patients were included in the study. The difference of uric acid level and immune indices between groups with different retinopathy severity was not statistically significant (p > 0.05). Lower duration of diabetes (p = 0.045), monocyte count (p = 0.021), and uric acid level (p < 0.001) were correlated with larger improvement in visual acuity at 3-month visit. Higher logarithm of the minimum angle of resolution of baseline visual acuity (p = 0.007), lymphocyte count (p = 0.008), lymphocyte to neutrophil ratio (p < 0.001) and lymphocyte to platelet ratio (p < 0.001) were correlated with larger improvement in visual acuity at 3-month visits. According to multivariate analysis, baseline logarithm of the minimum angle of resolution (r = 0.125, p = 0.009), duration of diabetes (r = −0.216, p = 0.047), lymphocyte to neutrophil ratio (r = 0.712, p < 0.001), lymphocyte to platelet ratio (r = 0.238, p < 0.001), and uric acid level (r = −0.397, p < 0.001) were the significant predictors of changes in visual acuity in our subset of patients.ConclusionsSerum uric acid and leukocyte counts and ratios may predict the response of diabetic macular edema to intravitreal injection.

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema.

PurposeTo identify biomarkers that may predict an early anatomical response to the treatment of diabetic macular edema (DME) with intravitreal bevacizumab (IVB) by means of optical coherence tomography angiography (OCTA).MethodsThis study is a retrospective study of treatment-naïve patients with DME who underwent 6 × 6 mm OCTA imaging of the macula at baseline and after three monthly IVB injections. Thirty-six eyes of 23 patients were included. Eyes that demonstrated evidence of an early anatomical response, consisting of a >10% decrease in central macular thickness (CMT) (n = 18), were compared with those eyes that failed to show such an improvement (n = 18).ResultsAt baseline, early-response eyes had worse starting best-corrected visual acuity (BCVA, LogMAR 0.84 ± 0.41 versus LogMAR 0.51 ± 0.15, p = 0.004) and a larger CMT (490 ± 135 µm versus 356 ± 33 µm, p = 0.001), but smaller foveal avascular zones (FAZ) (0.309 ± 0.098mm versus 0.413 ± 0.095 mm, p = 0.003) compared with eyes that proved refractory to three monthly injections of IVB. The vascular density (VD) in both the foveal superficial and deep capillary plexuses was significantly greater in eyes that showed an early-treatment response compared with eyes that were non-responders (24.86 ± 6.90% versus 19.98 ± 7.13%, p = 0.045 and 32.30 ± 4.88% versus 26.95 ± 7.25%, p = 0.028, respectively). Early-treatment response to IVB was predicted by starting CMT (r2= 0.266, p = 0.001), FAZ size (r2= 0.234, p = 0.003), and VD in the superficial parafovea (r2= 0.217, p = 0.004) and deep fovea (r2= 0.157, p = 0.037).ConclusionProjection-resolved OCTA may be useful in predicting an early anatomical response of DME to treatment with IVB.

Optical coherence tomography patterns of diabetic macular edema and treatment response to bevacizumab: a short-term study.

Background:The purpose of this study was to evaluate the short-term response of intravitreal bevacizumab in diabetic macular edema (DME) and assess the variation in treatment outcomes in different morphology patterns using spectral domain–optical coherence tomography (SD-OCT).Objective:To study different morphological patterns of DME based on OCT and compare their treatment response to bevacizumab.Methods:Hundred and twelve eyes of 112 patients with DME were included and treated with intravitreal bevacizumab (1.25 mg/0.05 ml monthly for 3 months). The morphological patterns of DME were classified on the basis of OCT into three groups – diffuse retinal thickening (DRT), cystoid macular edema (CME), and serous retinal detachment (SRD) – and changes in central macular thickness (CMT) and best corrected visual acuity (BCVA) after treatment were compared.Results:A total of 112 eyes with DME were included and consisted of 40 DRT, 37 CME, and 35 SRD. Treatment with bevacizumab resulted in decrease in central macular thickness and improvement in BCVA in all three groups. The baseline visual acuity and CMT of DRT group was better than that of the other two groups. The treatment outcome was measured in terms of CMT and BCVA. Change in CMT was statistically significant among three groups and was found to be better in DRT group (p < 0.05, 95% confidence interval). However, there was statistically no significant variation between the three groups regarding the change in BCVA (p = 0.169, 95% confidence interval).Conclusion:Anatomic and visual improvement can be achieved by bevacizumab in all patterns of DME. However, individual pattern may respond differently. DRT, which appears to be the earliest form of DME, responds better than other types. Thus, the pattern of macular edema shown by OCT may provide an objective guideline in predicting the response of bevacizumab injection in DME.

A Prospective Study of Safety Profile and Efficacy of three doses of Intravitreal Bevacizumab in Diabetic Macular Edema

Introduction: Current study aimed to evaluate efficacy of intravitreal Bevacizumab in Diabetic macular edema, and to identify their ocular and systemic complications if any.&#x0D; Method: It is a prospective, interventional study with 68 patients in 82 eyes with Diabetic macular edema. All treated by 3 injection of intravitreal bevacizumab with 1 month interval. Visual acuity, macular edema, and complications evaluated at every month upto 6th months. Ranibizumab was offered if the patient is a non-respondent to Bevacizumab.&#x0D; Results: Majority age group of 61-70 years with a mean age of 59 ± 6.72 years. The mean duration of diabetes was 11.68 ± 7.2 years. The mean baseline BCVA and CRT are 0.64 ± 0.28 Log MAR units and 436.99 ± 135.10 μm. After 3 injections, BCVA values are 0.48±0.27 (p&lt; 0.01)), 0.36±0.24 (p&lt;0.01)), and 0.27±0.24 (p&lt;0.01), 0.23±0.27 Log MAR (p&lt;0.01)) at 1month, 2 months, and 3 months, and 6 months follow-up respectively. CMT levels are 315.79±124.60 μ at 1 month, after 3rd IVA and this significant change (p&lt;0.01) followed with subsequent follow-up with mean CRT of 296.04±122.97 μ (p&lt; 0.01) at 6th month. The BCVA improved ≥ 2 Snellen lines in 69.5% and 78% cases, resolution of CMT in 56% and 69.5% cases at 3 months and 6 months respectively. At the end of the 3rd month, 46 eyes macular edema completely resolved with 3 injections of IVA, 23 eyes persistent macular edema present, 13 eyes refractory to bevacizumab injections. Persistent &amp; Refractory macular edema eyes (36) switched to Ranibizumab injections.In persistent macular edema, significant resolution (p≤0.01) of macular thickness (370.52 ± 71.43 µm vs. 341.08 ± 122.75 µm) without (p=0.09) improvement in visual acuity (0.45 ± 0.20 vs. 0.34 ± 0.23) was observed post Ranibizumab injections. In Refractory macular edema, thickness of cases no significant (497.76 ± 161.07µm vs 407.84 ± 169.64 µm) improvement seen after Ranibizumab injections(p=0.1). Recurrence of macular edema seen in 10.9%. Subconjunctival haemorrhage seen in 10.9%-12.1% cases, raised IOP in 2.4%-3.6% cases at post injection day 1. No other ocular and systemic complications were observed during follow-up.&#x0D; Conclusions: Intravitreal bevacizumab is effective in treatment of diabetic macular edema but therapeutic effect is temporary and repeat treatment is needed. It does not show any potential drug related ocular and systemic side effects, hence it is safe and economical therapeutic agent

Aflibercept versus Ranibizumab as a Second Line Therapy After Bevacizumab for Diabetic Macular Edema.

PurposeTo compare the visual and anatomic outcomes of aflibercept versus ranibizumab as a second line treatment for persistent diabetic macular edema (DME) after initial bevacizumab injections.MethodsIn this retrospective cohort study, patients with center-involved DME of ≥ 300 μm thickness after bevacizumab intravitreal injections in 2015–2019 were included. Those treated with ranibizumab (R) and aflibercept (A) were grouped as group R and group A, respectively. The change in central macular thickness (CMT) measured by optical coherence tomography (OCT) and the best corrected distance visual acuity (BCVA) before and after three-monthly anti-VEGF injections (anti-VEGF) in group R and group A were compared and reviewed.ResultsThere were 80 eyes of 75 patients in group R and 80 eyes of 72 patients in group A. The initial bevacizumab injections in group R and group A varied significantly (p = 0.01). The median change of the CMT after the three injections was not significantly different in group R (80 μm) and group A (81.5μm) (p = 0.7). The improvement of BCVA in group R and group A was not significant (p = 0.5). Dry macula was noted in 1 vs 14 eyes in group R vs group A.ConclusionAfter treating refractory DME with initial bevacizumab injections, 3 injections of either aflibercept or ranibizumab had similar anatomic and functional outcomes. Aflibercept achieved dry macula in more eyes with refractory DME compared to ranibizumab.

Bevacizumab for diabetic macular oedema: one-year treatment outcomes from the Fight Retinal Blindness! Registry.

This study evaluated the 1-year treatment outcomes of bevacizumab for diabetic macular oedema (DMO) in routine clinical practice. A retrospective analysis was performed on 298 eyes of 220 patients with DMO that received intra-vitreal bevacizumab between 1 September 2013 and 31 August 2018 that were tracked by a prospectively designed, web-based observational registry-the Fight Retinal Blindness! Registry. The mean visual acuity (95% confidence interval [CI]) at 1-year was 3 (2, 5) letters better thana mean (SD) of 68 (15) letters at study entry. Nearly a quarter of eyes achieved ≥20/40. Eyes presenting with better vision (≥20/40) tended to maintain that vision during the period of observation, whereas those presenting with worse vision (<20/40) gained a mean (95% CI) of 9 (5, 13) letters. A mean reduction in the macular thickness was observed over the study period with the central subfield improving by 29 µm (95% CI 17, 40) from a mean (SD) of 402 (109) µm at study entry. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 7 (4, 9) bevacizumab injections. Sixty-two eyes, ~20%, that started with bevacizumab changed to either another VEGF inhibitor or steroid (triamcinolone) during the period of observation. This did not lead to functional improvement for eyes changed to either ranibizumab or aflibercept despite a further reduction in macular thickness. An improvement in vision and reduction in macular thickness was noted in the 13 eyes that subsequently received triamcinolone. Approximately 10% of eyes dropped out over 12 months, even though their mean visual acuity had improved by seven letters from the initial visit. Bevacizumab is an effective treatment for DMO in unselected populations.

Effects of Oral Vitamin D Supplement Therapy on Clinical Outcomes of Intravitreal Bevacizumab in Diabetic Macular Edema.

PurposeTo assess the effects of oral vitamin D supplement therapy on clinical outcomes of intravitreal bevacizumab (IVB) injections in patients with diabetic macular edema (DME).Methods Seventy-one patients with center-involving DME received IVB injections three times monthly. Cases with serum 25-hydroxyvitamin D (25(OH)D) levels 30 ng/ml were divided into treatment and control groups. The treatment group received 50000 IU of oral vitamin D once a week for eight weeks. One month after the third IVB injection, changes in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) were analyzed for each group.ResultsThirty-seven patients had sufficient levels of 25 (OH) D, while 34 patients had insufficient levels. Nineteen cases with deficient levels of 25(OH)D were treated with oral vitamin D, while 15 patients were assigned to the control group. The mean of serum 25(OH)D in patients was 27.9 ng/ml [mean 20.3 5.4 and 17.3 5.4 ng/ml in control and treatment groups, respectively (P = 0.231)]. After three IVB injections, BCVA improved significantly in each group, but the difference between the study groups was not statistically significant. CMT decreased significantly in all the groups. The mean CMT reduction was more prominent in the vitamin D-treated group, but the difference between groups did not reach statistical significance (P = 0.29).Conclusion In DME patients with vitamin D deficiency, vitamin D supplement therapy had some beneficial effects on CMT reduction following three injections of IVB; nevertheless, these effects were not statistically significant. Definite conclusion needs further prospective studies with a larger sample size.

Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema: Exploratory Retrospective Analysis

AimTo evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in eyes with diabetic macular edema (DME) unresponsive to bevacizumab.MethodsSingle-center retrospective comparative study of patients with DME unresponsive to intravitreal bevacizumab that was switched to ranibizumab or aflibercept. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analysed prior to and 4 months after the switch. Ocular coherence tomography (OCT) biomarkers were also analysed.ResultsFifty-six eyes from 40 patients were included in the study, 33 eyes switched to ranibizumab and 23 to aflibercept. A significant median CFT decrease was observed in both groups (p<0.001), with no between-group differences. BCVA gain was only significant in the ranibizumab group (p<0.001). None of the pre-baseline or baseline parameters were associated with the response to ranibizumab or aflibercept.ConclusionIn persistent DME unresponsive to bevacizumab, both anatomical and functional improvements were observed with ranibizumab whereas aflibercept only showed an anatomical improvement. Clinicaltrials.gov NCT04018833.

The Impact of Race on Short-term Treatment Response to Bevacizumab in Diabetic Macular Edema

To determine the impact of race and ethnicity on efficacy of intravitreal bevacizumab for diabetic macular edema in anti-vascular endothelial growth factor (VEGF) treatment-naive patients. Retrospective cohort study. Setting: Urban-based academic institution with affiliated private offices. Intravitreal anti-VEGF naïve patients seen between 2010 and 2019 of White (W) race, Black (B) race, or Hispanic (H) ethnicity aged 18 years and older with diabetic macular edema who received intravitreal injections of bevacizumab. Exclusion criteria were prior intravitreal anti-VEGF treatment, invasive ophthalmologic interventions, and laser treatments within 3months prior to first injection through the duration of the study. Exposures: Intravitreal bevacizumab. Percentage of patients with visual acuity (VA) improvement and mean percentage reduction in central macular thickness (CMT). Percentage with VA improvement was 27% vs 39% vs 50% after 1 injection (n= 314), and 34% vs 55% vs 59% after 3 injections (n= 150) for B, H, and W cohorts, respectively. Black patients experienced lower odds of VA improvement compared with White and Hispanic patients after 1 injection (odds of 0.480, CI 0.284-0.814, P= .006) and 3 injections (odds of 0.342, CI 0.149-0.782, P= .008) while controlling for age, sex, baseline glycated hemoglobin (HbA1c), baseline CMT, baseline VA, laser history, injection time course, and follow-up delay. Black patients had a significantly lower likelihood of visual acuity improvement following intravitreal bevacizumab treatment compared with White and Hispanic patients. Further research is warranted to understand the effect of race and ethnicity on anti-VEGF efficacy to ensure optimal treatment for each individual.

Cost-consequence analysis of extended loading dose of anti-VEGF treatment in diabetic macular edema patients

BackgroundThe DRCR.net Protocol T clinical trial assessed the comparative efficacy and safety of anti-VEGF treatments including aflibercept, ranibizumab and bevacizumab in diabetic macular edema (DME). Post -hoc analyses showed that after a 12-week induction period, there was still DME resolution in an increasing number of patients through week 24.PurposeTo assess clinical and cost consequences of extending the anti-VEGF loading dose from 3 to 6 monthly injections in patients with persistent DME in Spain.MethodsFrom a hospital pharmacy perspective, a cost-consequence analysis model was developed to estimate the incremental cost needed to obtain an additional response at month 6. To estimate drug treatment costs, ex-factory prices (€, 2019) were considered for aflibercept, ranibizumab and bevacizumab. Response/nonresponse rates at 3/6 months were obtained from the Protocol T 24-week post hoc analysis (n = 546). Persistent DME was present in 50.8 and 31.6% of the 190 aflibercept-treated patients at month 3 and month 6, respectively. Of the 176 ranibizumab- and 180 bevacizumab-treated patients, 53.2 and 72.9%, respectively, had persistent DME at month 3, and 41.5 and 65.6%, respectively, had persistent DME at month 6. Sensitivity analysis considered the split of bevacizumab vials.ResultsExtending the loading dose in nonresponder patients would cost €214,862.57, €208,488.98 and €134,483.16 to obtain 37, 21 and 13 additional aflibercept, ranibizumab and bevacizumab responder patients, respectively. The total number of extended injections (months 3–6) used in patients with persistent DME at month 6 was 180, 219 and 354 for aflibercept, ranibizumab and bevacizumab, respectively.ConclusionsTo extend the anti-VEGF loading dose from 3 to 6 injections necessitates investing €5882.77 (8 injections), €10,091.03 (14 injections) and €10,198.59 (30 injections) per additional responder patient (3-month nonresponders and 6-month responders) to aflibercept, ranibizumab and bevacizumab, respectively. For the total of patients treated, on average €7927.02 (14 injections) per additional responder patient would be needed.

Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of &gt; ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value &lt; 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value &lt; 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

HbA1c as a predictor for response of bevacizumab in diabetic macular oedema

ObjectiveTo study the influence of glycosylated haemoglobin (HbA1c) on response of bevacizumab in patients with diabetic macular oedema.Methods and AnalysisA total of 37 eyes of 37 patients with vision loss...

The Short-Term Efficacy of Biweekly Subconjunctival Bevacizumab in Diabetic Macular Edema

ABSTRACTPurpose: To assess the effectiveness of subconjunctival bevacizumab (SB) injection every 2 weeks (biweekly) for diabetic macular edema (DME).Materials and Methods: In this prospective, non-randomized study; patients with clinically significant DME, who had central macular thickness (CMT) >300 µm, were included. They received three consecutive subconjunctival injections of 0.2 ml (5 mg) bevacizumab in biweekly intervals. Macular measurements were obtained by spectral-domain optical coherence tomography. The changes in CMT, and volumes of foveal (central 1 mm), parafoveal (between 1-3 mm), and perifoveal (3-6 mm) areas were followed.Results: Totally, 35 eyes of 26 patients with DME were included in the study. Five eyes were treatment-naive and 30 eyes were treatment non-naive. The means of CMT were 440.82 ± 101.22 µm at baseline, 380.11 ± 79.76 µm at second week, 338.34 ± 69.24 µm at first month, and 330.46 ± 74.16 µm at second month. Best-corrected visual acuity (BCVA) at baseline and second month were 0.56 ± 0.38 Log MAR (20/80) and 0.38 ± 0.35 Log MAR (20/50), respectively. While CMT, foveal, parafoveal, and perifoveal volumes significantly decreased after SB injections, a significant improvement in BCVA was found (p < .01 for all). No significant ocular or systemic adverse events were observed.Conclusions: Subconjunctival injection of bevacizumab every 2 weeks appears to be beneficial in the treatment of DME and it may provide significant anatomic and visual improvement, without ocular or systemic side effects.

Factors Predicting Treatment Response in Anti-Vascular Endothelial Growth Factor Naïve Diabetic Macular Edema Patients Treated with Intravitreal Bevacizumab.

Purpose: To identify factors that affect the therapeutic response of intravitreal bevacizumab in diabetic macular edema (DMO) and explore the correlation between the functional and anatomical outcomes observed. Methods: A retrospective, noncomparative, consecutive case series design was used. Baseline imaging data and clinical records of 65 eyes with DMO, secondary to type II diabetes mellitus, which received intravitreal bevacizumab for the first time in 2016, were analyzed. The central macular thickness (CMT), macular volume, and best-corrected visual acuity (BCVA), following the initial 3 injection loading phase were recorded. Outcomes were compared to multiple variables including glycemic control, diabetic retinopathy grade, DMO subtype on optical coherence tomography, and use of past macular laser therapy. Results: The participants' age ranged from 46 to 84 of which 63% were men and 37% were women. The mean baseline CMT was 443.21 μm. A mean reduction of 11.23% (P < 0.0005) in CMT was observed following the loading phase. Women exhibited a greater reduction in CMT (P = 0.032). Participants with diffuse retinal thickening (DRT) and with cystoid macular edema (CMO) showed a net reduction in CMT of 17.39% (P = 0.047) and 8.24% (P = 0.04) respectively. Eyes with proliferative diabetic retinopathy demonstrated a mean gain in CMT of 16.86% (P = 0.001). Conclusions: Female patients and DRT demonstrated a positive anatomical response. Patients with CMO and proliferative diabetic retinopathy displayed a negative therapeutic response. Such observations may be considered in clinical decision-making when opting for anti-vascular endothelial growth factor (VEGF) therapy for DMO.

Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema

Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema

Surgical Retrieval of an Intraocular Needle Following Intravitreal Bevacizumab Injection

Purpose: The purpose of this case report is to describe a case of iatrogenic intraocular foreign body due to a fractured 30-gauge needle following intravitreal injection of bevacizumab. Methods: A case report is presented. Results: The patient presented with a 30-gauge needle in the vitreous cavity after receiving an intravitreal injection of bevacizumab for diabetic macular edema. Bilateral eye shields were placed to reduce movement of the foreign body and decrease the risk of injury to the lens or retina. The needle was successfully removed via a combination of 23-gauge pars plana vitrectomy and removal of the foreign body via a transscleral approach through the initial injection site. Visual acuity improved to 20/25 2 months after surgery. Conclusions: We present the successful preoperative management and surgical removal of a needle fragment from the vitreous cavity after the needle fractured during intravitreal injection.

Retinal Ganglion Cell Complex Changes after Intravitreal Bevacizumab for Diabetic Macular Edema.

To measure the changes in ganglion cell complex as measured on optical coherence tomography (OCT) after intravitreal injection of bevacizumab (Avastin). Quasi-experimental study. Department of Ophthalmology, Lahore General Hospital, Lahore, from March 2017 to April 2018. Patients presenting to the Eye OPD were assessed for diabetic macula edema requiring intravitreal injection of anti-VEGF. Patients having any coexisting ocular pathology hindering the OCT measurement, i.e. corneal opacity, vitreous hemorrhage, retinal detachment or having macular edema secondary to other cases were excluded. Retinal ganglion cell complex thickness and signal strength was measured in superior, inferior, supero-nasal, superotemporal, infero-nasal and infero-temporal quadrants on OCT. Pre-injection, visual acuity was measured, OCT performed and the findings were recorded on a designed proforma. Post-injection, the patients were called for follow-up after one month at which time same measurements were evaluated. All the injections were administered by a single surgeon. The thickness of ganglion cell complex increased significantly (p <0.001) one month after Intravitreal injection of bevacizumab. Intravitreal administration of bevacizumab in diabetic macular edema affects the measurement of retinal ganglion cell complex thickness on OCT.