Consecutive Intravitreal Bevacizumab Injections Research Articles

Effects of Intra-Vitreal Diclofenac in Refractory Diabetic Macular Edema

Objectives: To see the effects of Intra-Vitreal Diclofenac injection (IVD) in refractory Diabetic Macular Edema (DME).
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan from Sep 2019 to Feb 2020.
 Methodology: Patients included in the study having Clinically Significant Macular Edema (CSME) with Central Macular Thickness (CMT) of more than 300 microns not responding to three consecutive Intravitreal injections of Bevacizumab (IVB).Intravitreal Diclofenac injection (500μg/0.1 ml) was given by the same retina fellow with the same protocol across all patients.Each patient was evaluated based on Central Macular Thickness (CMT) before intravitreal Diclofenac injection and on followup visits one week and one month after injection.
 Results: A total of 30 patients (30 eyes) were included in the study. Out of these, 11 were females, and 19 were males. The mean age of the patients was 57.87±4.424 years. Mean Central Macular Thickness (CMT) before injection was 439.67±110.45µm, after one week 398.47±110.55µm and 384.87±119.11µm after one month of intra-vitreal Diclofenac injection. Pre and post-injection central macular thickness (µm), which was clinically significant (p-value <0.001).
 Conclusion: Intravitreal Diclofenac injection (IVD) is effective in diabetic macular oedema, not responding to intravitreal antiVEGF (IVB) injections.

Comparison between post treatment vascular density, fractal dimension and choriocapillaris flow in ischemic and non-ischemic retinal vein occlusion using optical coherence tomography angiography

The aim of the study was to compare vascular density (VD), fractal dimension (FD), foveal avascular zone (FAZ) and choriocapillaris flow and using optical coherence tomography angiography (OCTA) before and after Bevacizumab therapy in patients with macular edema associated with ischemic and non-ischemic retinal vein occlusion (RVO). 15 eyes with ischemic RVO and 20 with non-ischemic RVO were included. Each patient had 3 consecutive intravitreal injections of Bevacizumab every month. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and retinal microvasculature were measured using OCTA before and one month after the third injection. The BCVA and FAZ area improved significantly after treatment in both ischemic and non-ischemic cases. Although, in ischemic group, FD, superficial and deep capillary VD decreased with no statistically significant change in the choriocapillaris flow. In the non-ischemic group, there was an increase in the FD, superficial parafoveal, perifoveal VD and choriocapillaris flow with insignificant increase in the DCP VD while the foveal VD showed a statistically significant decrease. In conclusion, anti-VEGF therapy improved the BCVA, retinal FD, VD in non-ischemic case but despite improvement in BCVA it reduced the VD in the ischemic cases.

Combined intravitreal injection of bevacizumab and a ROCK inhibitor (fasudil) for refractory macular edema secondary to retinal vein occlusion: a pilot study

BackgroundTo investigate the adjunctive effect of an intravitreal ROCK inhibitor (fasudil) in combination with intravitreal bevacizumab (IVB) on refractory macular edema secondary to retinal vein occlusion (RVO).MethodsIn this prospective interventional case series, 17 eyes of 17 patients (10 men, 7 women) with refractory RVO-related macular edema underwent three consecutive intravitreal injections of bevacizumab plus fasudil. Monthly evaluation was continued up to 12 months and IVB injection was performed if needed during the follow-up. Changes in the best corrected visual acuity (BCVA) was the primary outcome measure. The secondary outcome measures included central macular thickness (CMT) changes and any adverse events.ResultsBCVA significantly improved (mean change: −0.15 LogMAR; P = 0.017) after 3 consecutive intravitreal injections of fasudil in combination with bevacizumab. CMT significantly decreased (mean change: −206 µm; P = 0.028). The anatomical and functional improvement was maintained during the 12 month follow-up. No adverse effects were noticed.ConclusionIntravitreal ROCK inhibitors may break the resistance to anti-VEGF therapy and improve the RVO induced macular edema via affecting the VEGF-independent pathways.

Predictive value of the characteristics of intraretinal cystoid spaces on early response to antivascular endothelial growth factor treatment in patients with cystoid diabetic macular edema.

To evaluate whether baseline spectral-domain optical coherence tomography characteristics of intraretinal cystoid spaces predict visual outcomes in patients receiving intravitreal antivascular endothelial growth factor injection therapy (bevacizumab 1.25mg/0.05ml) for diabetic cystoid macular edema. The relationship between the properties of the cystoid spaces before injection and anatomic and functional results after injection were investigated in patients who received three consecutive intravitreal bevacizumab injections for cystoid macular edema. The best-corrected visual acuity for functional success and central subfield thickness for anatomical success were evaluated. The relationship of the location of the cystoid spaces with the integrity of photoreceptors and inner retinal layers was also evaluated. In 36 eyes of 36 patients, the mean best-corrected visual acuity significantly improved (p=0.002), and mean central subfield thickness decreased after injections (p=0.003). The improvement in best-corrected visual acuity was limited in eyes with outer nuclear layer cysts (p=0.045). Intracystic reflectivity was higher in eyes that poor best-corrected visual acuity than in eyes with successful visual outcomes (p=0.028). The disrupted ellipsoid zone was present in 13 (59.0%) of 22 eyes with outer nuclear layer cysts, whereas in only 1 of 14 eyes (7.1%) without outer nuclear layer cysts (p=0.009). Disorganization of retinal inner layers was present in 15 of 22 (68.1%) eyes with outer nuclear layer cysts, whereas only 2 of 14 (14.2%) without outer nuclear layer cysts had disorganization of retinal inner layers (p=0.013). Characteristics of intraretinal cystoid spaces may predict prognosis in patients with diabetic cystoid macular edema, and visual gain may be limited in the eyes with outer nuclear layer cysts.

Aqueous humor cytokine levels in patients with diabetic macular edema refractory to anti-VEGF treatment.

PurposeTo determine aqueous cytokines association with response to intravitreal bevacizumab (IVB) injection in diabetic macular edema (DME).MethodWe compared the concentrations of IL (interleukin)-1β, IL-2, IL-8, IL-10, IL-17, placental growth factor (PlGF), and vascular endothelial growth factor (VEGF) in the aqueous humor of 64 naïve DME patients with those of 13 cataract patients. Factors associated with central subfield thickness (CST) in DME patients were identified. DME patients were then subgrouped in terms of responsiveness to three IVB injections; cytokine concentrations were compared, and factors associated with responsiveness were identified.ResultsLevels of IL-2, IL-8, PlGF, and VEGF were significantly elevated in DME patients (p = 0.007, p < 0.001, p < 0.001, and p = 0.004 respectively). Regression analysis showed that the preoperative CST was associated with the preoperative best-corrected visual acuity and the aqueous IL-10 level (p < 0.001, p = 0.006, respectively). Of the 64 DME patients, 28 (43.75%) exhibited either CST < 300 μm or reduction in CST ≥ 50 μm after three consecutive IVB injections. On sub-group analysis, the mean IL-8 concentration was higher in the refractory group than in the responsive group, and multivariate logistic regression analysis showed that the IL-8 was the only factor associated with responsiveness (OR = 0.95, p = 0.017).ConclusionsThe IL-8 concentration in the aqueous humor was associated with responsiveness to IVB in DME patients.

Association Between Hyperreflective Dots on Spectral-Domain Optical Coherence Tomography in Macular Edema and Response to Treatment.

To investigate the association between hyperreflective dots (HRDs) on spectral-domain optical coherence tomography (SD-OCT) and response to intravitreal bevacizumab (IVB) or dexamethasone injection in eyes with diabetic macular edema (DME) or macular edema due to retinal vein occlusion (RVO). A retrospective review was conducted involving patients with DME or macular edema due to RVO. Patients with treatment-naïve macular edema were initially treated with three consecutive IVB injections and classified based on the treatment response to bevacizumab. After three consecutive IVB injections, bevacizumab nonresponders were treated using dexamethasone implants and reclassified based on the treatment response. The best-corrected visual acuity, number of HRDs, and outer plexiform layer (OPL) disruptions were analyzed according to the treatment response. Eighty-two eyes with DME and 68 eyes with RVO were included in this study. Thirty-six (43.9%) eyes with DME and 22 (32.4%) eyes with RVO were bevacizumab nonresponders. The number of baseline HRDs in bevacizumab nonresponders (16.06 ± 6.60 in DME, 14.23 ± 4.09 in RVO) was significantly greater than that in responders (11.26 ± 3.64, P < 0.001 in DME, 11.17 ± 4.83, P = 0.013 in RVO), and it did not decrease after IVB injections. Unlike the response to bevacizumab, eyes that responded to dexamethasone implant but not to IVB had significantly more HRDs (19.56 ± 6.75) than eyes that did not respond (11.50 ± 3.78, P = 0.006). The OPL disruption rate was significantly higher in bevacizumab nonresponders than in responders (P < 0.001 in DME and P = 0.001 in RVO). In patients with DME or macular edema due to RVO, the number of HRDs on SD-OCT may be a predictive indicator of the response to IVB injection or dexamethasone implant. In bevacizumab responders, the number of HRDs on SD-OCT was small. In contrast, more HRDs, which might reflect increased inflammation in the retina, were observed in dexamethasone responders. Therefore, dexamethasone implants might be more effective in DME or RVO eyes with multiple HRDs and OPL disruption on SD-OCT.

Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion.

PurposeTo evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant) for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO).MethodsThis was a retrospective, interventional case series. Medical records were reviewed, and a total of 38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond to at least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity (BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline, 2 months, and 6 months after DEX implantation.ResultsPatients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improved from 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and 6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 µm at baseline and changed to 293.21 ± 74.17 µm and 427.28 ± 119.57 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 µm at baseline and changed to 204.75 ± 74.74 µm and 226.86 ± 90.77 µm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVA at symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated with increased BCVA after treatment.ConclusionsThe DEX implant improves functional and anatomical outcomes for up to 6 months in about half of the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with low initial and baseline BCVA.

Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection.

PurposeTo evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure.MethodsPatients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography.ResultsForty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected.ConclusionsPosterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.

Dexamethasone Intravitreal Implant for Chronic Diabetic Macular Edema Resistant to Intravitreal Bevacizumab Treatment

Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone implant (Ozurdex) in patients with chronic diabetic macular edema (DME) resistant to prior intravitreal bevacizumab (IVB) treatment.Materials and Methods: Thirty eyes of 30 patients were administered intravitreal Ozurdex and examined at baseline and 1, 3, and 6 months postinjection in this prospective study. Main outcomes were the best corrected visual acuity (BCVA, logMAR), central foveal thickness (CFT), mean cube volume (MCV), and intraocular pressure (IOP). Patients had a CFT over 275 µm (measured by OCT) and were unresponsive to 3 consecutive IVB injections. All data are presented as mean ± standard deviation.Results: The mean BCVA significantly increased from 0.56 ± 0.38 to 0.41 ± 0.27 (p < 0.001), and 0.44 ± 0.28 (p = 0.008) at 1 and 3 months, respectively. At months 1, 3, and 6, the mean CFT significantly decreased from 517 ± 136 µm at baseline, to 290 ± 60 µm (p < 0.001), 314 ± 88 µm (p < 0.001) and 411 ± 126 µm (p = 0.01), respectively. However, the mean CFT (p < 0.001) and MCV (p = 0.01) significantly increased and BCVA significantly decreased (p = 0.04) at 6 month compared to 3 month. Compared to baseline, IOP increased significantly at 1 week (p = 0.01), 1 month (p = 0.01) and 3 months (p = 0.04). However eyes with IOP higher than 21 mmHg were treated and well controlled with topical anti-glaucoma monotherapy. Macular edema recurrence occurred in 25 eyes (CFT ranged from 321 µm to 800 µm) at 6 months.Conclusion: Dexamethasone intravitreal implant may be an effective and safe alternative in treatment of chronic DME nonresponsive to regular IVB. However, its therapeutic efficacy decreases between the third and sixth months following the injection.

Short-term efficacy of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion that is refractory to intravitreal bevacizumab.

Aims:To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab.Materials and Methods:This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection.Results:Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines.Conclusions:Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.

Long-Term Anatomical and Functional Outcome of Three Intravitreal Bevacizumab Injections for Persistent Macular Edema after Idiopathic Macular Epiretinal Membrane Peeling

Purpose: The aim of this study was to investigate the effect of three consecutive intravitreal bevacizumab injections (IVB) on long-term outcome for patients with macular edema after epiretinal membrane (ERM) removal. Methods: All patients in both the treatment and control groups had persistent macular edema 3 months after ERM removal. The patients in the treatment group received three consecutive IVB in an interval of approximately 4 weeks. The main outcome measures included logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and central foveal thickness (CFT) determined by optical coherence tomography. Results: Two weeks after the first IVB, CFT decreased significantly by 24.1 ± 4.2 μm in the treatment group versus 4.2 ± 2.1 μm in the control group (p < 0.001). However, the mean reduction in CFT after 12 months did not differ significantly between the two groups (35.2 ± 4.9 vs. 33.7 ± 4.6 μm, p = 0.824). No significant differences were found for logMAR BCVA between the two groups at each follow-up. Conclusion: IVB could significantly decrease macular edema 2 months after the initial injection but failed to make significant differences in final CFT and logMAR BCVA.

Extrafoveal changes following intravitreal bevacizumab injections for macular edema secondary to branch retinal vein occlusion: an mfERG and OCT study

To evaluate the functional and structural changes of extrafoveal macula after intravitreal bevacizumab (IVB) injection in patients with macular edema due to branch retinal vein occlusion (BRVO) using multifocal electroretinogram (mfERG) and optical coherence tomography (OCT). A total of 19 eyes of 19 patients with macular edema due to BRVO received three consecutive IVB injections with a 6-week interval. Spectral domain optical coherence tomography (SD-OCT), mfERG, and fluorescein angiography (FA) were performed at baseline. The macular area was divided into four quadrants (Q1-Q4) based on FA. The mean retinal thickness (MRT) and mfERG parameters in each of the four quadrants were measured at baseline and 4 weeks after the third injection. The MRT in the four quadrants improved significantly after IVB injections (p < 0.01 for Q1 and Q2, p < 0.05 for Q3 and Q4) compared to baseline. The significant improvements in mfERG responses were seen in Q1 and Q2. In Q1, there were 68 and 56% improvement in N1 and P1 amplitude, respectively (p < 0.01). N1 and P1 amplitude in Q2 increased significantly by 43 and 46%, respectively, compared to baseline (p < 0.05). The MRT and P1 amplitude were significantly correlated at baseline in Q1 and Q2, but no significant correlations were found after three IVB injections. The injection of IVB improved functional and structural outcomes in the primarily affected half of the extrafoveal macula effectively. The measurements of structural and functional changes using mfERG and OCT may be appropriate for monitoring the effects of IVB injection in BRVO patients.

Comparison of Intravitreal Bevacizumab Upload Followed by a Dexamethasone Implant versus Dexamethasone Implant Monotherapy for Retinal Vein Occlusion with Macular Edema

Purpose: To compare the efficacy and safety of three intravitreal bevacizumab upload injections followed by a dexamethasone implant versus dexamethasone implant monotherapy in eyes with macular edema due to retinal vein occlusion. Methods: Sixty-four eyes of 64 patients were included in this prospective, consecutive, nonrandomized case series: group 1 consisted of 38 patients (22 with central retinal vein occlusion, CRVO, 16 with branch retinal vein occlusion, BRVO) treated using a dexamethasone implant (Ozurdex) alone; group 2 consisted of 26 patients (14 CRVO, 12 BRVO) treated with three consecutive intravitreal bevacizumab injections at monthly intervals followed by a dexamethasone implant. In case of recurrence, both cohorts received further dexamethasone implants. Preoperatively and monthly best corrected visual acuity (BCVA, ETDRS), central retinal thickness (Spectralis-OCT), intraocular pressure, and wide-angle fundus photodocumentation (Optomap) were performed. The primary clinical endpoint was BCVA at 6 months after initiation of therapy. Secondary endpoints were central retinal thickness and safety of the therapy applied. Results: In group 1, an increase in BCVA of 2.5 (±1.6) letters in the CRVO and of 13.0 (±3.2) letters in BRVO patients was seen after 6 months, in group 2 of 5.9 (±0.4) letters (CRVO) and 3.8 (±2.4) letters (BRVO), which was not statistically significant. When comparing the two treatment groups with respect to the type of vein occlusion, there was a significant advantage for BRVO patients for the dexamethasone implant monotherapy (BRVO patients in group 1, p = 0.005). Central retinal thickness showed a significant reduction after 6 months only in patients of group 1, both for CRVO (p = 0.01) and BRVO (p = 0.003). First recurrence after the first dexamethasone implant injection occurred after 3.8 months (mean) in CRVO and 3.5 months in BRVO patients (group 1), versus 3.2 and 3.7 months, respectively, in group 2. In group 1, 63.6% with CRVO and 50% with BRVO showed an increased intraocular pressure after treatment; in group 2, 57.1% with CRVO and 50.0% with BRVO, respectively. Conclusion: In CRVO, there was no difference between the two treatment strategies investigated. However, in BRVO, dexamethasone implant monotherapy was associated with better functional outcome.

Intravitreal Bevacizumab for Choroidal Neovascularization Secondary to Best Vitelliform Macular Dystrophy in a 6-Year-Old Child

To report a young patient with choroidal neovascularization (CNV) secondary to Best vitelliform macular dystrophy (BVMD) who recovered good visual acuity with intravitreal bevacizumab (IVB). A 6-year-old boy was noted to have diminution of vision in both eyes. His best-corrected visual acuity (BCVA) was 20/40 in the right eye (OD) and 20/160 in the left eye (OS). Detailed examination including slit-lamp biomicroscopy, fluorescein angiography, and optical coherence tomography (OCT) showed active CNV in OS. Two consecutive IVB injections (1.25 mg/0.05 mL) were given in OS. During the follow-up, OD showed minimal subretinal fluid on OCT and was treated with one injection of IVB (1.25 mg/0.05 mL). At 9 months of follow-up, OS BCVA was 20/50 and OD BCVA 20/30 with presence of scarred CNV on fundus examination and OCT in both the eyes. No drug-related ocular or systemic side effects were encountered. Intravitreal bevacizumab appears to be a promising and cost-effective modality of treatment in CNV associated with BVMD with good visual recovery.

Time-Lag between Subretinal Fluid and Pigment Epithelial Detachment Reduction after Polypoidal Choroidal Vasculopathy Treatment

PurposeThe goal of the present research was to study post-treatment changes in polypoidal choroidal vasculopathy (PCV) shown by optical coherence tomography (OCT).MethodsThe study included 12 patients with naive PCV. Photodynamic therapy and 3 consecutive intravitreal bevacizumab injections at 6-week intervals were given. Best corrected visual acuity, subretinal fluid (SRF), pigment epithelium detachment (PED), central macular thickness (CMT), and total macular volume (TMV) were measured before and after treatment as assessed by Stratus OCT3.ResultsAfter treatment, the SRF height decreased earlier than the PED height. The SRF diameter decreased with statistical significance. However, the PED diameter did not show a statistically significant improvement, persisting at pre-treatment levels. Both CMT and TMV decreased significantly after treatment.ConclusionsAfter PCV treatment, SRF and PED stabilized, as shown by OCT. However, the PED treatment response was both delayed and refractory compared to the SRF response. The small change in post-treatment PED diameter may suggest the possibility of PCV recurrence.

The Development of Recurrent Choroidal Neovascularization in a Patient with Choroidal Coloboma

We report a case of recurrent choroidal neovascularization (CNV) in an eye with chorioretinal coloboma. A 36-year-old woman presented complaining of decreased visual acuity (VA) in her left eye. Best corrected visual acuity (BCVA) was 20/200 and iris coloboma was observed. Funduscopy and fluorescein angiography (FA) showed CNV in the superior extrafoveal region with chorioretinal coloboma reaching just inferior to the optic disc. No other cause for CNV was observed except for the chorioretinal coloboma. BCVA improved to 20/30 after laser photocoagulation. She revisited our clinic for deteriorating VA (20/400) in the same eye 3 years after treatment. Funduscopy and FA demonstrated recurrent CNV with subfoveal hemorrhage. Photodynamic therapy (PDT) was followed by three consecutive intravitreal bevacizumab injections (IVB) for the subfoveally-located CNV. However, the CNV persisted with the appearance of a fresh subretinal hemorrhage. Additional PDT was combined with IVB on the same day 6 months after the initial PDT. The CNV regressed 3 months after treatment and has not recurred as of 8 months after the last treatment. The patient's BCVA improved to 20/60. This case suggests that PDT combined with IVB can be an alternative treatment for the management of recurrent CNV after laser photocoagulation in eyes with chorioretinal coloboma.

INTRAVITREAL BEVACIZUMAB FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION

The purpose of this study was to assess an association between specific types of subfoveal neovascularization and the change in visual acuity after intravitreal injections of bevacizumab (F. Hoffmann-La Roche AG, Basel, Switzerland) as treatment for exudative age-related macular degeneration. This retrospective clinical interventional comparative study included 307 patients (378 eyes) who received 3 consecutive intravitreal injections of bevacizumab at intervals of 2 months each. The study group was divided into eyes with a predominantly or purely classic type of subfoveal neovascular membrane (n = 81), those with an occult type with or without minimally classic subfoveal neovascularization (n = 232), and eyes with a detachment of the retinal pigment epithelium (n = 65). The gain in best-corrected visual acuity did not vary significantly among the 3 subgroups at 2 months after baseline (P = 0.35 and P = 0.27), at 4 months after baseline (P = 0.63 and P = 0.56), or at the final follow-up at 7 months after baseline (P = 0.85 and P = 0.76). In multivariate linear regression analysis, the gain in best-corrected visual acuity at the final follow-up was significantly associated with the best-corrected visual acuity at baseline (P < 0.001). It was not significantly associated with age (P = 0.61), sex (P = 0.12), self-reported diabetes (P = 0.79), lens status (P = 0.84), or type of subfoveal neovascularization (P = 0.53). After an intravitreal application of bevacizumab given as therapy for exudative age-related macular degeneration at 2-month intervals, the patient's gain in visual acuity did not depend on the type of the subfoveal neovascular membranes.

Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle

Intravitreal injections may lead to a significant elevation of the intraocular pressure (IOP). A paracentesis may become necessary for acute reduction of the IOP in certain cases. The purpose of this study was to determine the frequency of paracentesis performed and the grade of reflux under the conjunctiva after injection of 0.1 ml bevacizumab (1.25 mg), depending on the thickness of the needles used. A retrospective review was undertaken of the surgery reports of 234 consecutive intravitreal bevacizumab injections in 145 eyes of 144 patients within 14 months. In particular, the frequency of paracentesis, the thickness of the needles used (27-gauge versus 30-gauge), the lens status, and a semi-quantitative reflux grade were analysed. A paracentesis was performed in 78 cases (33%) for acute reduction of the IOP. In the 27-gauge group the frequency was 26% (25 of 96), and in the 30-gauge group 38% (53 of 138) (p = 0.05, independent estimating equation (IEE)). The medians of the semi-quantitative assessment of the reflux grade under the conjunctiva were 2.0 in the 27-gauge group (corresponding to a mild reflux) and 1.0 in the 30-gauge group (corresponding to a minimal reflux, p < 0.001, IEE). When using a 30-gauge needle for intravitreal injections, the reflux under the conjunctiva was less than with a 27-gauge needle. However, the use of a 30-gauge needle appeared to be associated with a higher frequency of paracentesis.

Intravitreal bevacizumab for choroidal neovascular membrane associated with Best′s vitelliform dystrophy

Best's vitelliform macular dystrophy is a hereditary form of progressive macular dystrophy that can be complicated by choroidal neovascularization. Authors report successful treatment of choroidal neovascularization with intravitreal bevacizumab in one such eye in an ‘adult’ Indian male with visual improvement. A 23-year-old male presented with diminution of vision in the right eye for the past sixteen months. Visual acuity was 20/400 in the that eye. After three consecutive intravitreal injections of bevacizumab (1.25 mg/0.05 ml), vision improved to 20/120. Seven months following the last injection of bevacizumab, fundus appeared stable and visual acuity was maintained. No drug-related ocular or systemic side effects were encountered. To the best of our knowledge (PubMed search), this is the first report of its kind in an adult Indian patient. Intravitreal bevacizumab appears to be a promising and cost-effective modality of treatment in such eyes with potential for improvement in vision. However, a long-term follow-up is warranted.

The Effect of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection on Intraocular Pressure

Purpose: To compare intraocular pressure (IOP) changes after intravitreal triamcinolone acetonide versus bevacizumab injection. Methods: IOP was measured in 40 patients who received an intravitreal injection of 0.1 ml triamcinolone and 40 patients who received 2 consecutive intravitreal injections of bevacizumab (0.05 ml and 0.1 ml). Patients were divided into three groups : 0.1 ml triamcinolone group (0.1 IVTA group), 0.05 ml bevacizumab group (0.05 IVB group), and 0.1 ml bevacizumab group (0.1 IVB group). IOPs were compared within groups at different time points (before, 1 day after, and 30 days after the injection) and between groups at the same time points. Results: In the 0.05 IVB and 0.1 IVB groups, IOP at 1 day after injection was significantly lower than before injection (P