Effect Of Intravitreal Bevacizumab Research Articles

Effects of intravitreal Bevacizumab (Avastin) monotherapy in central retinal vein occlusion in young subjects.

To evaluate the efficacy of anti-angiogenic agent Bevacizumab in central retinal venous occlusion treatment. To determine the efficacy of Bevacizumab and ophthalmological parameters such as best corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography (OCT) in central retinal venous occlusion in patients aged less than 30. This is a prospective, interventional study, done on 25 eyes of 25 patients aged 30 years and below with central retinal venous occlusion, who received intravitreal Bevacizumab injections for three consecutive months. The mean change in best corrected visual acuity (BCVA), and central macular thickness (CMT) measured by optical coherence tomography were compared and correlated at baseline after 3 months and 6 months follow-up. The mean best corrected visual acuity and the central macular thickness on OCT improved significantly from 1.08±0.29 and 454.80±114.5µm at baseline to 0.77±0.32 logMAR units and 339.7±82.5µm after 6 months follow up. The current study showed that intravitreal Bevacizumab at a dose of 1.25 mg and with strict control of systemic contributory parameters seemed to improve BCVA and CMT and macular edema measured at baseline to 3 months and 6 months follow-up after three consecutive monthly injections.

Effect of Intravitreal Bevacizumab on the Optic Nerve Head perfusion in patients with Diabetic Macular Edema

Purpose: To find out the effect of Intravitreal Bevacizumab on optic nerve head perfusion using Ocular Coherence Tomography Angiography (OCTA) in patients with diabetic macular edema (DME). Study Design: Interventional case series Place and duration of study: Ophthalmology Department, Mayo Hospital, Lahore from June 2018 to January 2020. Methods: In this study 57 eyes of patients fulfilling the inclusion criteria were selected from the outpatient department. After informed consent, detailed history and ocular examination was performed. Baseline OCTAwas donein all cases. The patients received intravitreal Bevacizumab (1.25mg in 0.05ml). OCTA was repeated three weeks after injection. Both the pre and post injection ONH perfusion was compared and analyzed using SPSS. Demographic chracteristics like age and gender were calculated. Paired sample t-test was applied to check the significance of difference between pre and post injection values. P-value of <0.05 was considered significant. Results:There were 16(28.1%) males and 41(71.9%) females. Mean age of the patients was 53.54±7.00 years. Pre injection blood flow was 56.11 and post injection was significamtly reduced to 52.69. The mean difference between was 3.423 and confidence interval of the difference was (2.5755-4.2701). P-value 0.000 was <0.05 whichshowed significant reduction in perfusion of ONH. Conclusion:Intravitreal Bevacizumab decreases the optic nerve head blood flow and should be used with care in patients having reduced blood flow states and also in patients with advanced glaucomatous optic neuropathy.

Effect of intravitreal bevacizumab in the uninjected fellow eye of patients treated for retinal disorders

Elevated levels of VEGF is implicated in the pathogenesis of ocular neovascular diseases such as exudative age-related macular degeneration, proliferative diabetic retinopathy, diabetic macular edema, central and branch retinal vein occlusion, neovascular glaucoma, and retinopathy of prematurity. Bevacizumab a full-length humanized murine monoclonal antibody is being used as an off-label drug in the treatment of above disorders. When administered intravitreally, bevacizumab may have a therapeutic effect in the uninjected fellow eye. The objective of the present study is to determine the effects in the untreated fellow eye of intravitreal bevacizumab after a single dose in the contralateral affected eye in patients with similar retinal pathology. The study was a non-randomized, interventional prospective study. Thirty consecutive patients with similar retinal pathologies in both the eyes were enrolled. All patients in the study underwent a detailed ophthalmic examination including a dilated fundus examination. All patients underwent fundus fluorescein angiography and optical coherence tomography of macula. All suitable patients identified were given intravitreal injections of 1.25 mg bevacizumab. The eye to be injected was selected based on the severity of pathology, affecting the macular status, as depicted by the clinical picture, visual acuity, OCT and FFA. The injections were given under topical anaesthesia. Patients were subsequently followed up on day 2, day 7 and day 21. After 4 weeks FFA and OCT were repeated. The results were tabulated and statistical analysis was done.The study included 30 eyes of 30 patients with similar retinal pathology in both the eyes the mean age of patients was 64 yrs. 10 eyes had AMD, 9 eyes had PDR, 5 eyes had CNVM, 3 eyes had CME, 2 eyes had myopic CNVM, 1 eye had CRVO. The mean visual acuity at presentation in the uninjected fellow eye was 0.69 ± 0.41 log MAR units. All patients received atleast one intravitreal injection of bevacizumab 1.25mg in one of the affected eyes and the response was observed in the fellow eye. Among the 30 patients who received injection, 29(72.5%) patients showed some improvement in visual acuity chart after the first injection in the fellow eye and in 11(27.5%) patients vision remained same. The initial improvement was seen within one week in most patients. The mean central macular thickness in the fellow eye on OCT at baseline 515.64 + 1.

Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry?

Aim Bevacizumab may affect preterm infants’ ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO. Methods Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70. Results LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (p<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, p<.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar (p > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (p<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups (p > .05). Moderate and severe developmental delays were similar between groups (p > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups, p > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups, p > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO (p > .05). Odds of NDI was not effected by ROP treatment type (p > .05). Conclusions Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.

Acute and chronic effects of intravitreal bevacizumab on lung biomarkers of angiogenesis in the rat exposed to neonatal intermittent hypoxia

Purpose/Aim Intravitreal bevacizumab (Avastin) is an irreversible vascular endothelial growth factor (VEGF) inhibitor used to treat severe retinopathy of prematurity (ROP) in extremely low gestational age neonates (ELGANs). ELGANs who are at the highest risk for developing severe ROP often experience brief intermittent hypoxia (IH) episodes which may cause oxidative damage. We tested the hypothesis that intravitreal Avastin leaks into the systemic circulation during exposure to IH and has adverse effects on biomarkers of pulmonary microvascular maturation, thus leading to pulmonary hemorrhage and long-term pulmonary sequelae. Methods Neonatal rats at postnatal day (PN) 0 (birth) were exposed to either: 1) hyperoxia (50% O2) or 2) neonatal IH (50% O2 with brief episodes of 12% O2) from PN0 to PN14. Room air (RA) littermates served as controls. At PN14, the time of eye opening in rats, a single dose of Avastin (0.125 mg in 5 µL) was injected into the vitreous cavity of the left eyes. A control group received equivalent volume saline. At PN23 and PN45, blood gases, lung-to-body weight ratios, histology, immunofluorescence, and lung biomarkers of angiogenesis were examined. Results At PN23, Avastin increased lung VEGF, nitric oxide derivatives (NOx), and hypoxia-inducible factor (HIF)1a in the hyperoxia-exposed groups, but decreased soluble VEGFR-1 (sVEGFR-1). At PN45, lungs from animals exposed to neonatal IH and treated with Avastin were severely hemorrhagic with morphologic changes in lung architecture consistent with chronic lung disease. This was associated with higher VEGF and NOx levels, and lower insulin-like growth factor (IGF)-I and sVEGFR-1. Conclusions These findings prove our hypothesis that intravitreal Avastin penetrates the blood–ocular barrier in IH and alters lung biomarkers of angiogenesis. Avastin targeting of VEGF could affect normal lung development which may be exaggerated under pathologic conditions such as IH, ultimately leading to vascular permeability, vessel rupture, and pulmonary hemorrhage.

Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial.

Diabetic retinopathy (DR) may progress following cataract surgery due to surgery-induced inflammation. The effect of intravitreal bevacizumab (BVB) and triamcinolone acetonide (TCA), which have differing anti-inflammatory properties, on DR progression following cataract surgery has not been reported. To report the progression of DR in diabetic patients undergoing cataract extraction treated with intravitreal BVB or TCA during the surgery. Post hoc analysis of 6-month data from a prospective, randomized, double-masked clinical trial. Diabetic patients with clinically significant cataract and fovea involving diabetic macular oedema (DME), or a recent history of DME. Participants were randomly allocated 1:1 to receive intravitreal BVB 1.25 mg or TCA 4 mg during and post-cataract surgery as needed. The rate of DR progression between groups was compared. DR progression. There were 61 eyes included. Patients receiving BVB were older than those receiving TCA (70.2 vs 64.3 years; P < .05). Three participants (10.7%) in the BVB and three (9.09%) in the TCA group had a one-step progression, while none in BVB and only one (3%) in the TCA group demonstrated two-step DR progression. In the majority of these patients, DR progression was from mild to moderate non-proliferative diabetic retinopathy. In this study, BVB and TCA groups had a similar, and lower rate of DR progression compared to previous studies where no adjunctive treatment was administered, suggesting that patients with DME may benefit from either intraoperative intravitreous BVB or TCA injection to reduce the risk of DR progression following cataract surgery.

Neurodevelopmental outcomes following intravitreal bevacizumab injection in Japanese preterm infants with type 1 retinopathy of prematurity.

PurposeThe purpose of this study was to evaluate neurodevelopmental outcomes in 18-month old (corrected age) preterm infants who received an intravitreal bevacizumab (IVB) injection for the treatment of type 1 retinopathy of prematurity (ROP).MethodsIn this ten-year retrospective study, we reviewed the medical records of patients who underwent ROP screening at Kyushu University Hospital. Among the patients who received IVB or laser photocoagulation (LPC) for the treatment of type 1 ROP, we included infants whose neurodevelopmental examination (the Kyoto Scale of Psychological Development [KSPD]) results at 18 months corrected age were available. Then, the effect of IVB on the developmental quotient (DQ) in each KSPD domain (Postural-Movement, Cognitive-Adaptive, or Language-Social domain) or the overall DQ was investigated by performing linear regression analysis.ResultsOut of the 513 patients reviewed, 53 were included in the study. IVB and LPC were performed for 14 and 39 patients, respectively. Administration of IVB was significantly associated with neurodevelopmental delay in the Language-Social domain (p = 0.01). The observed association remained even after adjusting for gestational age and birth weight (p = 0.03).ConclusionsAdministration of IVB may introduce a risk of developmental impairment of interpersonal relationships, socializations, and/or verbal abilities of preterm children. We recommended that preterm infants who received IVB undergo a neurodevelopmental reassessment during their school years or in adulthood.

A real-world study of effectiveness of intravitreal bevacizumab and ranibizumab injection for treating retinal diseases in Thailand

BackgroundTo evaluate the effectiveness of intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) in actual practice for treating patients with retinal diseases in Thailand.MethodsA prospective, multi-centre, observational study was conducted among eight hospitals in their ophthalmology outpatient departments. Participants consisted of patients who had previously not received any IVB or IVR treatment between 2013 and 2014. The primary outcome measurement was the change in best-corrected visual acuity (BCVA) at the end of the follow-up period compared to baseline.ResultsThere were 1629 treatment-naïve patients for the pro re nata (PRN) treatment pattern and 226 treatment-naive patients for the three-injections (3Inj) treatment pattern. BCVA improvements were found in 35% of the PRN group and 47% of the 3Inj group; however, it was not clinically meaningful between the IVB and IVR groups (P-value = 0.568 for PRN, P-value = 0.103 for 3Inj). A multivariable logistic regression (using the propensity score) showed that positive factors associated with vision improvement for the PRN pattern were the number of drug injections, having retinal vein occlusion, and under 60 years of age, while good BCVA at baseline was a negative predictive factor. For the 3Inj pattern, under 60 years of age and baseline BCVA were statistically significant predictors. Nonetheless, diabetes mellitus (DM) without other comorbidities was a statistically significant predictor of low response to vision improvement compared to DM with other comorbidities.ConclusionsThis study was the first observational, prospective study to evaluate the real-life effectiveness of IVB and IVR in Thailand. The majority of participants who used IVB or IVR showed improvements in BCVA after treatment. Further evaluation such as long-term follow-ups and subsequent comparison of effectiveness between IVB and IVR should be investigated due to the limited sample of IVR patients.Trial registrationThai Clinical Trial Registry TCTR20141002001. Registered 02 October 2014 (retrospectively registered).

Effects of intravitreal bevacizumab in Gram-positive and Gram-negative models of ocular inflammation.

Exogenous endophthalmitis is a potential complication of intraocular surgery and frequently results in visual impairment. Current treatment involves administration of intravitreal (IVT) antibiotics with or without vitrectomy surgery. Evidence for the use of adjunctive anti-inflammatory agents is conflicting. We set out to determine if bevacizumab, a humanized monoclonal IgG1 antibody targeted against vascular endothelial growth factor (VEGF), has anti-inflammatory properties in experimental models of Gram-positive and Gram-negative inflammation. BALB/c mice were subjected to lipopolysaccharide- (LPS) or peptidoglycan- (PGN) induced ocular inflammation and treated with IVT bevacizumab. Iris microvasculature was imaged 6 hours following irritant/treatment using intravital microscopy (IVM) before the mice were euthanized and the eyes were enucleated immediately post-mortem. Following enucleation, levels of VEGF and 23 cytokines and chemokines (IL-1α, IL-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-10, IL-12 (p40), IL-12 (p70), IL-13, IL-17, TNF, KC, G-CSF, GM-CSF, Eotaxin, INF-γ, MCP-1, MIP-1α, MIP-1β, RANTES) were quantified using a multiplex assay. Levels of VEGF were significantly increased during the inflammatory response, triggered by either PGN or LPS. Both the adherence of leukocytes to the iris vascular endothelium and the levels of pro-inflammatory cytokines and chemokines were significantly increased following administration of either irritant. Treatment with bevacizumab decreased levels of leukocyte adherence in LPS-treated eyes, however, not in PGN-treated eyes. Conversely, bevacizumab treatment decreased levels of cytokines and chemokines (TNF, IL-6, MCP-1, MIP-1α, MIP-1β, RANTES, KC) in PGN-treated eyes, however, not in LPS-treated eyes. Within a 6-hour window bevacizumab had anti-inflammatory actions that were distinct in both Gram-positive (PIU) and Gram-negative (EIU) models, respectively. Given our findings, this would suggest that bevacizumab may have utility as an adjunctive therapy to IVT antibiotics and vitrectomy in the management of exogenous endophthalmitis.

Effect of intravitreal Bevacizumab on macular edema secondary to retinal vascular occlusion

Objective: To find out the effect of intravitreal injection of Bevacizumab on central macular thickness (CMT) and best corrected visual acuity (BCVA) in cases of retinal vascular occlusion (RVO). Material and method: All the patients of RVO treated at our institute over a period of 1 year, with a central macular thickness of more than 250µ were included in the study. Intravitreal injection of Bevacizumab was given and the CMT and BCVA were measured after a control period of 1 month. The injection was repeated at intervals of 1.5 months if decrease in CMT was less than 30%. Result: Out of the total 78 patients there was a significant improvement in BCVAin 58 patients. There was a significant decrease in central macular thickness in all of them. Conclusion: Anti-VEGF agent Bevacizumab causes significant reduction in central macular thickness and improves BCVA in cases of macular edema secondary to retinal vascular occlusion.

Effect of Intravitreal Bevacizumab with or without Macular Photocoagulation for Diabetic Macular Edema: A Meta-Analysis.

IntroductionIn this meta-analysis, we aimed to assess the possible benefits of macular photocoagulation (MPC) as an additional treatment with intravitreal bevacizumab (IVB) in patients with diabetic macular edema.MethodsThe studies were identified from three databases: PubMed, Web of Science, and the Cochrane Library. The main outcome measures included change in best-corrected visual acuity (BCVA), differences in central macular thickness (CMT), and adverse events within the follow-up period. The results were pooled using weight mean difference with their corresponding 95% confidence intervals. A fixed or random effects model was employed, depending on the heterogeneity of the inclusion trials.ResultsFinally, three randomized controlled trial and two high-quality retrospective studies were identified and included. Changes in CMT at 1, 3, and 6 months did not vary significantly between the IVB-alone group and the IVB with MPC group (P = 0.26, 0.06, and 0.65, respectively). Similarly, changes in BCVA at 1, 3, and 6 months also did not vary significantly between the two groups (P = 0.20, 0.91, and 0.70, respectively). Whereas substantial heterogeneity was detected in the CMT results among these studies, the sensitivity analyses showed Solaiman’s study was probably the source of the heterogeneity. No publication bias was detected by funnel plots in this study.ConclusionResults of this meta-analysis showed that the treatments with IVB alone and combined IVB and MPC were similarly effective in improving BCVA and reducing CMT. However, more evidence is needed to evaluate their effects in the long-term periods.

Comparison of Retinal Nerve Fiber Layer Thickness Changes after Intravitreal Bevacizumab in Patients of Diabetic Macular Edema

Diabetic macular edema is one of the leading causes of visual loss in diabetic patients. However, the impact of medicinal treatment on the occurrence of macular edema remained elusive. Objectives: This study was designed to determine the effect of intravitreal bevacizumab in patients of diabetic macular edema.Methods: An interventional study was conducted on patients that underwent pre-injection and one-month post-injection OCT for RNFL thickness. OCT was performed by researchers and findings were recorded accordingly. The retinal nerve fiber layer thickness was measured in superior, inferior halves and total average thickness. Pre- and post-injection OCT were conduced and macular thickness were documented. Results: The mean retinal nerve fiber layer thickness was decreased in superior and inferior halves as well as in the total thickness. Conclusion: Intra vitreal bevacizumab decreases the retinal nerve fiber layer thickness. Large randomized controlled trials are required to establish or rule out any association between this decrease in thickness and incidence if glaucoma in such patients.

Effect of intravitreal bevacizumab and aflibercept on retrobulbar blood flow in injected and uninjected sound eyes of patients with neovascular age‐related macular degeneration

PurposeTo evaluate early changes in retrobulbar blood flow following intravitreal injection of anti‐vascular endothelial growth factor (VEGF) agents.MethodsTen patients affected by neovascular age‐related macular degeneration in 1 eye were enrolled. Five eyes received intravitreal bevacizumab (1.25mg/0.05mL) and 5 eyes aflibercept (2mg/0.05mL). Retrobulbar blood flow was examined by color doppler ultrasonography (Aplio 500, Toshiba Medical System, Tokyo, Japan). Peak systolic velocity (PSV) and resistivity index (RI) was measured from ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) in both injected and uninjected sound eyes, before and 21 days after treatment.ResultsBefore and after intravitreal bevacizumab mean retrobulbar blood flow parameters significantly change in PCA: PSV 15.24±3.96 cm/sec vs 12.90±2.63 cm/sec (p=0.0012), RI 0.74±0.02 vs 0.77±0.07 (p=0.009) and in CRA: PSV 14.16±1.8 cm/sec vs 12.29±1.54 cm/sec (p=0.005), RI 0.77±0.03 vs 0.79±0.03 (p=0.029). In the sound fellow eyes, significant changes resulted in PCA: PSV 17.26±3.45 cm/sec vs 13.63±3.3 cm/sec (p=0.003), RI 0.74±0.05 vs 0.79±0.03 (p=0.026). Before and after intravitreal aflibercept measured data significantly change in PCA: PSV 12.8±3.09 cm/sec vs 7.20±0.62 cm/sec (p=0.023), RI 0.68±0.03 vs 0.77±0.03 (p=0.007) and in CRA: PSV 14.28±1.2 cm/sec vs 11.04±0.77 cm/sec (p=0.037), RI 0.73±0.03 vs 0.78±0.05 (p=0.022). In the sound fellow eyes, significant changes resulted in PCA: PSV 12.44±2.89 cm/sec vs 9.18±1.42 cm/sec (p=0.044), RI 0.69±0.05 vs 0.75±0.02 (p=0.028).ConclusionsIntravitreal injections of bevacizumab and aflibercept significantly reduce ocular hemodynamic parameters both in treated and in untreated eyes. These evidences suggest a possible systemic effect.

Effect of intravitreal bevacizumab on subfoveal choroidal thickness in eyes with diabetic macular edema

PurposeThe purpose of this study was to evaluate the changes in subfoveal choroidal thickness (SFCT) in eyes with diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection.Patients and methodsThirty eyes diagnosed as nonproliferative diabetic retinopathy with DME were included in this prospective study. All eyes received an intravitreal injection of 1.25 mg/0.05 ml bevacizumab. Best-corrected visual acuity, SFCT, and central macular thickness were measured and recorded before the IVB injection and 1 month after the injection. The choroidal thickness was measured using enhanced depth imaging technique of Heidelberg Spectralis-optical coherence tomography.ResultsThe mean age of the patients was 55.63±4.6 years, with a mean duration of diabetes of 8.26±1.96 years. The mean preinjection SFCT was 214.3±7.9 μm. The mean SFCT after 1 month of IVB injection was 215.5±6.8 μm, with no significant difference from the preinjection value (P=0.56). The mean change in the SFCT 1 month after intravitreal injection was 1.1±9.5 μm, with 0.5% change ratio. The correlation between change in SFCT and changes in central macular thickness and best-corrected visual acuity were 0.24 and −0.3, respectively, which were insignificant (P=0.2 and 0.09, respectively).ConclusionThe IVB injection has no effect on the SFCT in eyes with DME.

The effect of intravitreal bevacizumab and ranibizumab on macular edema of the contralateral eye: A comparative study of two anti-VEGFs.

Purpose:To compare the effects of bevacizumab and ranibizumab on the visual function and macular thickness in the contralateral (untreated) eye of patients with bilateral diabetic macular edema (DME).Materials and Methods:Thirty-nine patients with bilateral DME, who had been treated with both bevacizumab and ranibizumab in the same eye, were considered retrospectively for this study. Recorded outcome measurements included the best-corrected visual acuity (BCVA) assessment with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the central subfield macular thickness (CSMT) measurement of the contralateral, uninjected eye before and at 4 weeks after the injections.Results:The median BCVA of the uninjected eye was 50 ETDRS letters and the median CSMT was 459 μm preceding the bevacizumab injection whereas at the control appointment, 4 weeks after the injection, the median BCVA had increased to 52 letters (P = 0.098), and the median CSMT had decreased to 390 μm (P = 0.036). The mean interval between the bevacizumab and ranibizumab treatments was 4.79 ΁ 1.52 months. The measurements of the untreated eye after the ranibizumab treatment showed that the median BCVA decreased from 55 to 52 letters, and the median CSMT increased from 361 μm to 418 μm (P = 0.148 and P = 0.109, respectively).Conclusions:In contrast to ranibizumab, the intravitreal administration of bevacizumab resulted in a statistically significant decrease in macular thickness in the untreated eye in patients with bilateral DME.

Effect of intravitreal bevacizumab on choroidal thickness in eyes with retinal vein occlusion and diabetic macular oedema

AbstractPurposeTo evaluate choroidal thickness (CT) before and after intravitreal bevacizumab injections in eyes with macular oedema due to retinal vein occlusion and diabetic maculopathy.MethodsIn this pilot study, 18 eyes of 16 patients were treated with intravitreal bevacizumab injections. The central macular thickness was measured at baseline and after treatment with intravitreal bevacizumab using spectral domain optical coherence tomography (SD‐OCT). The choroid was evaluated using SD‐OCT with EDI mode (Spectralis® HRA+OCT, Heidelberg Engineering) at the fovea before and after intravitreal bevacizumab.Results18 eyes were treated with 1.25 mg of intravitreal bevacizumab every 4 weeks, with at least three injections per eye and then continued if oedema persisted. The mean number of intravitreal bevacizumab injections per eye was three. The subfoveal choroidal thickness was significantly thinner after intravitreal anti‐VEGF treatment (214.82 ± 62.67 μm) than at baseline (265.52 ± 87.67 μm, P &lt; 0.001). The mean central macular thickness decreased significantly after treatment with intravitreal bevacizumab (265.53 ± 83.20 μm) compared to baseline (522.63 ± 305.62 μm, P &lt; 0.005). Decrease in central macular thickness did not correlate with decrease in subfoveal choroidal thickness.ConclusionsIn eyes with macular oedema due to retinal vein occlusion and diabetic maculopathy, treatment with intravitreal bevacizumab significantly reduced subfoveal CT and central macular thickness.

Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients.

To investigate factors associated with good response to intravitreal bevacizumab (IVB) in central serous chorioretinopathy (CSC) patients. We retrospectively reviewed 42 eyes of CSC patients of symptom duration more than 3 months who received a single or multiple successive IVBs on an as-needed basis (0.05 ml, 1.25 mg). High responders (HRs) were defined as complete resolution of subretinal fluid (SRF) on spectral domain optical coherence tomography (SD-OCT). Moderate responders (MRs) were defined as SRF resolution of 50-99% of pretreatment volume and poor responders (PRs) as SRF resolution <50%. Clinical, SD-OCT, fluorescein, and indocyanine green angiography findings were analyzed to find factors associated with HR. Descriptive statistics for all demographic and clinical variables were calculated, and comparisons were made using Wilcoxon's matched-pairs signed-rank test, the Mann-Whitney U-test for means with continuous data, Pearson's χ(2) test, and Fisher's exact test for categorical data. The mean number of IVB was 1.9. At postoperative 1 month, there were 10 (24%) HRs, 18 (43%) MRs, and 14 (33%) PRs. At the last follow-up (the mean 8.6 months), there were 25 HRs (60%), 9 MRs (21%), and 8 PRs (19%). Thicker subfoveal choroid (P=0.036), smaller lesion diameter (P=0.019), and better baseline best-corrected visual acuity (P=0.002) predicted HRs at postoperative 1 month. HR at the last follow-up was associated with classic pattern fluorescein angiography finding. Suboptimal effects of IVB on persistent CSC suggest primary IVB on selective cases with better vision, smaller lesion, and thicker choroid at baseline.

Effect of Intravitreal Bevacizumab Injection on Iris and Iridocorneal Angle Neovascularization in Neovascular Glaucoma

Neovascular glaucoma is a serious complication associated with retinal ischemic changes, which increase the production of vascular endothelial growth factor. Vascular endothelial growth factor has been implicated as a key molecule in the development of newly formed vessels and neovascular glaucoma. Intravitreal injection of bevacizumab, a full-length humanized anti-vascular endothelial growth factor monoclonal antibody, leads to a dramatic regression of the new iris and iridocorneal angle vessels on slitlamp examination. However, anterior segment angiography reveals that bevacizumab does not cause a regression of the neovascular vessels themselves but reduces vascular permeability while newly formed vessels are still present in the iris and iridocorneal angle. This review focuses on the pathology and diagnosis of neovascula glaucoma and the effect of intravitreal bevacizumab on the iris and iridocorneal angle neovascularization.

Effect of intravitreal bevacizumab on diabetic macular edema with hard exudates.

BackgroundWe evaluated the efficacy of intravitreal bevacizumab on diabetic macular edema with subfoveal and perifoveal hard exudates.Materials and methodsEleven eyes (11 patients) exhibiting diabetic macular edema with subfoveal and perifoveal hard exudates were included in this prospective, nonrandomized interventional pilot study. All patients were treated with monthly scheduled intravitreal bevacizumab injections for 6 months. Changes in the Early Treatment Diabetic Retinopathy Study best corrected visual acuity, amount of hard exudates on fundus photography, and macular edema detected by central subfield thickness on spectral domain optical coherence tomography after six serial injections, were assessed. The amount of hard exudates at each visit was evaluated as pixels in fundus photography, using an Adobe Photoshop program.ResultsTen of 11 patients completed follow-up. The mean Early Treatment Diabetic Retinopathy Study best corrected visual acuity was 59.9±5.7 letters (Snellen equivalent, 20/63) at baseline evaluation. The best corrected visual acuity exhibited no significant difference at month 6 compared with at baseline (57.9±6.0 letters or 20/70 at month 6; P=0.085). At month 6, mean central subfield thickness decreased from 370.4±56.5 to 334.6±65.0 μm (P=0.009). The mean amount of hard exudates increased from 4467.1±2736.1 to 6592.4±2498.3 pixels at month 6 (P=0.022). No serious adverse events occurred.ConclusionContinuous intravitreal bevacizumab was found to have no benefit in visual acuity and amount of hard exudates, despite the improvement of macular edema at 6 months.

The effect of intravitreal bevacizumab on ocular blood flow in diabetic retinopathy and branch retinal vein occlusion as measured by laser speckle flowgraphy.

BackgroundThis study evaluated the effect of intravitreal injection of bevacizumab (IVB) on macular edema associated with diabetic retinopathy (DME) or branch retinal vein occlusion (BRVOME) using laser speckle flowgraphy.MethodsA comparative interventional study of 25 eyes from 22 patients with macular edema (DME group: 12 eyes; BRVOME group: 13 eyes) who underwent IVB. Mean blur rate (MBR) was measured in the retinal artery, retinal vein, optic nerve head (ONH), and choroid before and after IVB.ResultsIn the BRVOME group, there was no significant change in MBR in the retinal artery, retinal vein or ONH, but choroidal MBR decreased significantly (P=0.04). In the DME group, the MBR in the retinal artery, retinal vein, ONH, and choroid decreased significantly (P=0.02, P=0.04, P<0.001, and P=0.04, respectively). In the DME group, pre-IVB MBR in the ONH was significantly correlated with post-IVB foveal thickness (R= −0.71, P=0.002). There was no such correlation in the BRVOME group in the ONH.ConclusionIVB had a suppressive effect on circulation in eyes with DME but not in those with BRVOME. This suggests that this noninvasive and objective biomarker may be a useful part of pre-IVB evaluations and decision-making in DME.