Avastin Injection Research Articles

Treatment Options and Referral Pattern among Patients with Retinal Diseases Attending an Eye Clinic in a Tertiary institution, North Central Nigeria.

Objectives: The aim of the study was to determine the treatment modalities and pattern of referral of patients with retinal diseases in the eye clinic. Methods: All consenting new patients attending the eye clinic were recruited for the study and interviewed by the author. The treatment offered to the participants diagnosed with retinal disease (medical, surgical, LASER, optical or a combination) was recorded. Information on the patient’s referral for vitreoretinal consultation (this could be ‘yes’ or ‘no’) and reasons for the referral were also documented and analyzed. Results: treatment options for the 278 study participants were: medical for 100 (36%), optical for 94 (33.8%) optical correction, surgical for 24 (8.6%), LASER photocoagulation for 6 (2.2%) and a combination of LASER photocoagulation and intravitreal avastin injection for 20 (7.2%) patients. Counselling and watchful expectancy accounted for treatment of 34 (12.2%) patients. Seventy-four patients of the 278 included in the study had retinal diseases. Of these 74 with retinal diseases, 46 (62.2%) were referred to vitreoretinal units out of which 39 (84.8%) patients were referred to the vitreoretinal unit in JUTH and 7 (15.2%) were referred to vitreoretinal units elsewhere. The referrals were largely on account of unavailability of requisite equipment in 3 (42.8%) patients, surgical expertise in 2 (28.6%) patients and patient request in 2 (28.6%) cases. Conclusion: The need for establishment of standard vitreoretinal services strategically in each geo-political zone of Nigeria to cater more efficiently to the needs of patients with retinal diseases and appropriate referral cannot be overemphasized

Event of Visual Impairment and Loss with Off-Label Administration of AVASTIN Injection

Event of Visual Impairment and Loss with Off-Label Administration of AVASTIN Injection

Efficacy of Anti-VEGF in Treatment of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that affects premature infants. Vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of ROP. Anti-VEGF agents can potentially inhibit abnormal vessel growth in ROP. This study aimed to evaluate the efficacy of anti-VEGF (bevacizumab) in treatment of ROP. A prospective study was conducted on 75 patients including 70 adults and 5 ROP babies who received intravitreal injection of bevacizumab (Avastin). Distant visual acuity, slit lamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT) were assessed at baseline, immediate, 1 week and 4 weeks post injection. Statistically significant improvement was observed in distant visual acuity and reduction in macular thickness after Avastin injection. At 4 weeks, best corrected visual acuity of 6/6 was attained by 15 adults and 3 ROP babies. OCT revealed decreased macular edema with mean reduction of 115.29μm. ROP subjects showed greater visual gain (mean acuity improvement - 2.4 lines) as compared to adults (mean acuity improvement - 1.52 lines). Significant correlation was found between better visual acuity and macular thickness less than 300μm. Intravitreal Avastin resulted in rapid regression of neovascularization in ROP. No ocular or systemic complications were observed. Single injection controlled disease progression in majority of cases. Anti-VEGF agents can be considered as primary modality for treating type 1 ROP due to their safety, efficacy and long-term benefits. Larger studies are required to establish optimal dosage and long-term effects.

Retrospective Study of Diabetic Retinopathy and Macular Edema in Southern Part of Bangladesh.

Diabetic mellitus is a vision-threatening disease because it causes diabetic retinopathy worldwide. The main focus of this research is to determine the prevalence and assess the visual outcome in diabetic retinopathy and macular edema patients by injecting Bevacizumab clinically. This hospital-based trial case was conducted in Khulna BNSB Eye Hospital, Bangladesh. This study is based on a prospective cohort with a population of macular edema in 41 eyes of 25 diabetic patients, of whom 94 were diagnosed with diabetic retinopathy in 320 type 2 diabetes mellitus patients. The treating physician inserts 1.25 mg (0.05 ml) into the patient's eye. We have used optical coherence tomography (OCT) and colour fundus photography (CFP) for an eye check performed on all patients before and after the injection of Bevacizumab. The method results analyze the effects of the technique using IBM SPSS 25. The study population selected 25 patients with 41 eyes for clinical investigation by injection of Bevacizumab. The net effects of this study on five eyes with macular edema were entirely resolved. It was BCVA from 6/6 to 6/9. The 29 eyes were partially resolved, which is called improved visual acuity, and BCVA was 6/12 to 6/60. In the case of seven eyes, we found that the vision did not change before or after the Avastin injection. No change was seen in seven eyes of macular edema due to the effects of the Avastin injection before and after. In clinical trial-based research, Bevacizumab (Avastin) is best effective for diabetic retinopathy (DR) and diabetic macular edema (DME) patients.

Pterygium Excision with Application of Mitomycin C in Comparison to Sub-Pterygium Injection of Avastin without Excision

Pterygium Excision with Application of Mitomycin C in Comparison to Sub-Pterygium Injection of Avastin without Excision

Evaluation of Cystoid Macular Edema in Patients with Retinal Vein Occlusion, Makkah Eye Hospital, Aden, Yemen

Background: Cystoid macular edema (CMO) represents a common pathologic sequel of the retina. This study aimed to study the occurrence of cystoid macular edema in patients with retinal vein occlusion. Materials and methods: We reviewed retrospectively the medical records of 54 retinal vein occlusion patients in Makkah eye hospital in Aden, from January to December 2021. The collected data analyzed by SPSS version 22. Chi-square test was used and a p-value less than 0.05 was determined as statistically significant. Results: The total study patients with retinal vein occlusion (RVO) were 54, (males 63.0% and females 37.0%). The mean age was 58.2 ± 12.7 years. The most side involvement of branch retinal vein occlusions (BRVO) was in the right eyes with (25%) and of central retinal vein occlusions (CRVO) in (30%), (p > 0.05).The total number of eyes with RVO was 60 eyes, of which 26 eyes were with BRVO and 34 eyes with CRVO. In eyes with BRVO (35.0%) developed CMO while in eyes affected by CRVO, (31.7%), (p < 0.05). We found higher intra-ocular pressure (IOP) > 21 mmHg in CRVO with (18.4%) while in BRVO were in (8.3%), (p > 0.05).There was a positive correlation between hypertension and RVO (P < 0.05) and there was no significant relation in this study between glaucoma and occurrence of RVO (p > 0.05). The visual acuity after receiving the Avastin injections improved in all visual acuity groups. Conclusion: In this study, males were predominant. The CRVO was the commonest type of RVO. Some patients with CRVO and BRVO developed CMO. The relation between values of BRVO and CRVO related to the occurrence of CMO was statistically significant (p < 0.05). Keywords: Evaluation, cystoid macular edema, retinal vein occlusion, Aden, Yemen

Efficacy of intravitreal bevacizumab on diabetic macular oedema in an African population.

To evaluate the short-term effect of intravitreal bevacizumab (avastin) injection on visual outcomes of patients with diabetic macular oedema. A retrospective cross-sectional study was conducted to evaluate 39 eyes of thirty-nine patients (mean age ± SD: 61.4 ± 15.0years) that received intravitreal bevacizumab injection (1.25mg in 0.05ml) as treatment for diabetic macular oedema between January 2014 and July 2019 in Ghana. Data on visual acuity and central macular thickness before treatment and 6weeks post-treatment were collected and analysed using paired t-test. Ordinary least squares linear regression analysis was also conducted to determine the relationship between improvement in visual acuity and central macular thickness after treatment and other predictor variables. The mean ± SD visual acuity (LogMAR-equivalent of Snellen) of patients with diabetic macular oedema significantly improved from 0.84 ± 0.58 LogMAR before treatment to 0.69 ± 0.58 LogMAR at 6weeks post-treatment (mean difference: 0.15 ± 0.32 LogMAR; 95% CI: 0.04 to 0.25; p = 0.01). Mean macular thickness ± SD on the other hand, reduced significantly (p < 0.001) from 316.54 ± 75.35μm before treatment to 275.54 ± 57.43μm after treatment. While age and worse pre-treatment visual acuity predicted improvement in visual acuity after treatment, a higher central macular thickness before treatment predicted an improvement in central macular thickness after intravitreal bevacizumab injection. Treatment with intravitreal bevacizumab injection produces short-term improvement in vision and reduction in central macular thickness in African patients with diabetic macular oedema.

Endophthalmitis After Intravitreal Bevacizumab (Avastin) Injections: An Outbreak Investigated.

Purpose To investigate an endophthalmitis outbreak in different eye hospitals after intravitreal (IVT) bevacizumab (Avastin) injections over two days. Place and duration of the study Mughal Eye Hospital, Nov 2022 to Jan 2023. Materials and methods All cases reported with endophthalmitis in Mughal Eye Hospital after administration of anti-vascular endothelial growth factor IVT injections in different hospitals on November 8-9, 2022, were studied. In all endophthalmitis cases, one to five IVT injections of antibiotics (vancomycin, ceftazidime, and dexamethasone) were given depending on the clinical picture. Results Thirty-six eyes of 34 patients who developed endophthalmitis were included in the study. Age (mean 53 years) ranged from 44 years to 70 years. There were 18 males and 16 females. Two patients had bilateral endophthalmitis. Thirty-three patients were given two to four IVT injections of antibiotics depending on the clinical response. Five cases of vitreous tap done before injecting antibiotics were found to have Pseudomonas. Anterior chamber wash was done in 15 cases to improve visualization for doing pars plana vitrectomy (PPV). In 24 patients PPV with silicon oil was done. Eighteen patients showed improvement as their hypopyon disappeared after IVT antibiotic injections. One patient developed corneal sloughing (she refused IVT antibiotic injections). One patient developed malignant/pupil block glaucoma. In two eyes, early PPV was done. Four eyes developed no perception of light. In our series, endophthalmitis patients started reporting one day after the injection. One patient who developed bilateral endophthalmitisdeveloped bilateral cataracts with subluxations. One patient developed retinal detachment. One eye developed choroidal detachment. Conclusion IVT bevacizumab (Avastin) may be associated with an outbreak of endophthalmitis. Pseudomonas endophthalmitis is a very grave condition associated with severe morbidity.

Visual Results of Intravitreal Bevacizumab (Avastin) Treatment for Branch Retinal Vein Occlusion a Multi Center Study

Objective: To evaluate the visual outcomes in patients with branch retinal vein obstruction after intravitreal bevacizumab (Avastin) injection. Study Location and Duration:, Department of Ophthalmology Abaseen hospital and Khyber medical center Peshawar from January 2019 to January 2022 both department conducted this multi-center study. Methodology: Patients with BRVO received at least one intravitreal Bevacizumab (Avastin) injection of 1.25 mg in 0.05 ml. Snellen visual acuity tests, Fundus Fluorescein Angiography (FFA), and Optical Coherence Tomography were used to assess the patients (OCT). A complete eye exam was conducted before treatment began, and monthly follow-up examinations were scheduled for the following six months. Results: The total number of patients and eyes was 78, with a mean age of 60. (SD 15.1). The average number of Intravitreal bevacizumab (Avastin) injections administered to patients was four (SD 1.40) per eye. There were no negative consequences observed. Before treatment, the average central macular thickness was 568 microns, but after three months it was only 370 microns (p0.001), and by six months it had decreased to 290 microns. Three months later, the average acuity was much better than at the start (p=0.001), with log MAR = 0.30 (SD 0.22). During the most recent 6-month follow-up, the mean visual acuity was log MAR = 0.40 (SD 0.23), better than the baseline value (p 0.001). Overall, 44 eyes showed an improvement in their vision. Conclusion: Intravitreal Bevacizumab intravitreally for branch retinal vein occlusion improves vision. Bevacizumab intravitreally enhances visual acuity, macular edema, and ischemia. Bevacizumab reduces the risk of vision-threatening vitreous hemorrhage and neovascularization. Hence, Bevacizumab improves vision and treats branch retinal vein occlusion effectively. Keywords: Intravitreal Bevacizumab (Avastin), Branch Retinal Vein Occlusion (BRVO), Visual Acuity Improvement, Macular Ischemia Relief. Retinal Neovascularization Reduction

Evaluation of the Vascular Density, the Area of Foveal Avascular Zone, and Corrected Vision in Patients with Diabetic Macular Edema after Anti-VEGF Therapy

Background and Objective: This study aimed to evaluate the changes in macular superficial and deep capillary plexus (SCP and DCP) density, Foveal Avascular Zone (FAZ) area, and visual acuity in patients with diabetic macular edema after anti-VEGF therapy. Materials and Methods: This descriptive-analytical study utilized before and after treatment design. In total, 30 eyes of 30 patients with diabetic macular edema were investigated in this study. Optical Coherence Tomography Angiography (OCTA) images were taken at baseline (before injections) and at visits after injections (30 days after injections). The patients were treated with intravitreal injection of Avastin (Bevacizumab) with a dose of 2.5 mg per month. Macular vessel density of the SCP and DCP, as well as FAZ area were measured in each OCTA. Best corrected visual acuity (BCVA) was measured at baseline visit and at last visit (30 days after the third injection). Results: The mean age of patients was 57.33 years. Vessel density in SCP, DCP, and FAZ area were found to be significantly different before and after one, two, or three intravitreal injections (P&lt;0.001). However, vessel density was not found to be significantly different in SCP, DCP, and FAZ area among one, two, or three intravitreal injections (P&gt;0.05). Moreover, BCVA was not significantly different before and after intravitreal injections (P&gt;0.05). Conclusion: In this study, macular vessel density and FAZ area statistically changed following the intravitreal injections of Bevacizumab; however, they were unchanged among three injections. In addition, the BCVA remained unchanged before and after treatment. Anti-VEGF effect on macular perfusion may cause a direct change in the micro vascular flow.

Outcome of intravitreal Avastin® injections in patients with macular oedema in Uganda: a cohort study

BackgroundTo determine the outcome of Intravitreal Avastin (IVA) injections in patients with Macular Oedema (MO) in Uganda.MethodsWe prospectively recruited patients presenting with MO at the Department of Ophthalmology of Mbarara University of Science and Technology in Southern Uganda from November 2018 to April 2019. We treated them with intravitreal injection of Bevacizumab (Avastin®) and followed them up for three consecutive months after the initial injection. We collected information on baseline clinical presentation and 3 month outcomes. We performed a Student’s t-test to compare central macular thickness (CMT) and best corrected visual acuity (BCVA) at baseline and at 3 months after IVA injections. We performed linear regression to test for predictors of change in CMT and BCVA at 3 months.ResultsWe enroled 32 patients (35 eyes) of which 29 patients (32 eyes) completed the follow up. The mean age was 62.8 ± 11.8 years, and 53% were male. At 3 months after IVA, the mean CMT improved significantly from 426.90 ± 135.9 µm at baseline to 311.20 ± 134.80 µm (p = 0.0008). The mean BCVA improved from 0.70 ± 0.38 at baseline to 0.38 ± 0.36 logMAR units (p = 0.003). The improvement in CMT and BCVA were more marked in patients who had Diabetic ME compared to other causes. A high baseline CMT was a strong predictor of improvement in CMT at 3 months after IVA therapy. A worse baseline visual acuity was a predictor of improvement in vision at 3 months after IVA.ConclusionsIVA therapy results in anatomical and visual improvement at 3 months especially in patients with Diabetic MO. Having a high baseline CMT was a predictor of good CMT outcome at 3 months while a worse vision at baseline was a predictor of better visual outcome at 3 months.

A Rare Case of Bilateral Post Intravitreal Avastin Endophthalmitis with Bilateral Good Visual Outcome – A Case Report

This is a case report of post intravitreal injection endophthalmitis encountered at the University Teaching Hospitals–Eye Hospital in Lusaka, Zambia. Endophthalmitis is a clinical diagnosis made when intraocular inflammation involving both the anterior and posterior chambers is attributable to bacterial or fungal infection. Post injection endophthalmitis is a dreaded complication that occurs following intraocular surgery or procedures such as intravitreal administration of anti-vascular endothelial growth factors or corticosteroids. We attended to a rare case of bilateral post intravitreal injection endophthalmitis in a 51- year- old female patient who presented with bilateral severe pain and acute visual loss in both eyes following intravitreal injection of Avastin (bevacizumab) the previous day. On examination, there was severely decreased visual acuity from 6/36 right eye and 6/60 left eye to hand movement in both eyes. There was also corneal haziness, fibrin in the anterior chambers, hypopyon and vitreous cells in both eyes. A clinical diagnosis of bilateral post-injection endophthalmitis was made. There was immediate administration of intravitreal antibiotics of Vancomycin 1.0mg/0.1mL and Ceftazidime 2.25mg/0.1mL with intravitreal Dexamethasone 0.4mg/0.1ml stat dose and systemic ciprofloxacin 750mg 12 hourly for 7 days. Due to prompt diagnosis and treatment vision recovery was excellent in both eyes and both eyes were preserved.

Effect of local anti-vascular endothelial growth factor therapy to prevent the formation of stenosis in outflow vein in arteriovenous fistula.

ABSTRACTBackground and Objectives:Vascular stenosis and angiogenesis are the major causes of short expectancy of arteriovenous fistula (AVF). Increased expression of vascular endothelial growth factor-A (VEGF-A) has been suggested to play an important role in the pathophysiologic process. Anti-VEGF has been proved to be effective on anti-angiogenesis and applied in clinical practice, but its effect on anti-stenosis remains to be verified before it could be applied to prevent stenosis of AVF. This study was aimed to evaluate the effect of local anti-VEGF therapy to prevent the formation of stenosis in the outflow vein in AVF and its mechanism.Methods:Bioinformatics of VEGF-A and its downstream-regulated molecules from the STRING PPI database were analyzed in this study. The biopsy samples from outflow veins of AVF in patients and C57BL/6 mouse models were analyzed to examine the mechanisms of pathologic vascular stenosis associated with VEGF pathways and their potential therapeutic targets.Results:We found that the reduction of VEGF-A could downregulate downstream molecules and subsequently reduce the intimal hyperplasia and abnormal vascular remodeling by analyzing the STRING PPI database. Venous wall thickening, intimal neointima formation, and apoptosis of vascular endothelial cells in the proliferative outflow vein of the AVF were significantly more obvious, and upregulation of expression of VEGF was observed in dysfunctional AVF in patients. In mouse models, the expression of VEGF, Ephrin receptor B4 (EphB4), matrix metalloproteinase (MMP)2, MMP9, tissue inhibitor of metalloproteinase (TIMP)1, TIMP2, and caspase 3 in the control-shRNA surgical group was significantly higher than in the sham group (P < 0.05), and all of these indicators were significantly lower in lentiviral transfection group and Avastin group than in control-shRNA surgical group (P < 0.05) on the 14th day after AVF operation.Conclusion:VEGF expression is significantly increased in vascular endothelial cells in stenosed or occluded outflow veins of dysfunctional AVF. Local injection of Avastin into the adventitia of the proximal outflow vein in autologous AVF procedure has an excellent potential to prevent the subsequent local stenosis of the proximal outflow vein.

The efficacy of intralesional injection of bevacizumab (Avastin) in the management of primary pterygium

Background Pterygium is a triangular encroachment of the conjunctiva onto the cornea. Objectives This study aimed to assess the role of anti-vascular endothelial growth factor (Avastin) in the management of primary pterygium. Patients and methods This was an interventional study. This study was carried out at the Ophthalmology Department of AL-Zahraa University Hospital. The study period was from October 2019 to September 2020. Thirty eyes from 30 patients with primary pterygia were included in this study. Results There was a difference in visual acuity between preinjection of Avastin and 3 months postinjection by mean −0.10±0.10; 16 patients showed an improvement (53.3%), while 14 patients were stable (46.7%). There is a difference in astigmatism between preinjection of Avastin and 3 months postinjection by mean (−0.15±0.33); 10 patients showed an improvement (33.3%), while 20 patients did not show an improvement (66.7%). No increase in astigmatism occurred in any patient postinjection. There was a highly significant decrease in color intensity starting from the 2nd week till the end of the 3rd month postinjection. There was no significant change in ocular tension postinjection. Conclusion Our results showed that Avastin injection is a viable option in arresting the progress of pterygium and improving the cosmetic appearance, with a slight decrease in pterygium dimensions, which in turn improved the degree of astigmatism produced by pterygium.

A classic case of ischemic central retinal vein occlusion with macular edema

Central retinal vein occlusion (CRVO) is a significant cause of marked or total loss of vision in the middle-aged and elderly population. The patient was a 54-year-old man with a history of uncontrolled diabetes and was given seven intravitreal bevacizumab (Avastin) injections as treatment. The patient was advised to follow-up during the next 6 months, including gonioscopy and undilated examination of the iris to look for the iris/disc neovascularization. We presented a classic case of unilateral ischemic CRVO with macular edema, in whom diabetes is the leading risk factor. Close follow-up and diabetes control are advisable to prevent a similar scenario.

Role of bevacizumab intraocular injection in the management of neovascular glaucoma.

To assess the long-term effects of intraocular bevacizumab (Avastin) injections as an adjunctive drug to manage patients with neovascular glaucoma (NVG). A retrospective study was conducted consisting of 34 eyes with secondary NVG caused by proliferative diabetic retinopathy (n=25), ischemic central retinal vein occlusion (n=8), and retinal ischemia resulting from persistent detachment (n=1) were managed by intraocular injections of bevacizumab (1.25 mg/0.05 mL), in addition to other treatments. The main outcome measure was the change in the degree of iris neovascularization. Secondary outcomes included intraocular pressure and the number of additional interventions or antiglaucoma medications administered after injection. All patients were followed-up for at least 12mo. At the last follow-up, complete regression of rubeosis irides was detectable in 13 (38.2%) eyes and incomplete regression in 21 eyes (61.8%). The mean intraocular pressure was 45.32±7.185 mm Hg at baseline and significantly decreased to 26.15±5.679 mm Hg at the last follow-up visit (P=0.000005). Patients received an average of 4.97 injections. As additional treatments, 12 eyes (35%) received laser photocoagulation and 6 eyes (18%) underwent retinocryopexy. No further treatment was needed in 16 eyes (47.1%). Intravitreal bevacizumab injection can have a favorable effect in controlling intraocular pressure and pain control in patients with NVG because it decreases the angiogenesis and helps to augment the results of conventional procedures. The primary cause of retinal ischemia should be always targeted.

Long-Term Maintenance of Vision and Resolution of Vitelliform Lesions with Systemic Phosphodiesterase 5/6 Treatment (Sildenafil)

BACKGROUND: Adult vitelliform macular dystrophy results in loss of central vision. The use of systemic sildenafil has been proven to increase choroidal blood flow. This is a report of a favorable long-term treatment outcome using systemic sildenafil for a patient with adult onset vitelliform macular dystrophy. CASE PRESENTATION: A 55-year-old woman presenting with bilateral subretinal vitelliform lesions was initially assessed by full-field electroretinogram, electro-oculogram and direct sequencing of the RDS/PRPH2 and BEST1 genes. Best-corrected visual acuity, spectral domain-optical coherence tomography and color fundus photography were obtained and analyzed over a 5-year treatment course which included bevacizumab (Avastin) injections in the right eye and left eye and subsequent ranibizumab (Lucentis) treatments in the left eye. Lipid resolution in the right eye was seen with bevacizumab after two months of treatment, while the left eye was unresponsive to eight subsequent injections of bevacizumab, followed by ranibizumab over a period of twenty months. Systemic sildenafil was started, off label, at 20 months following course of intravitreal injections. Following initiation of sildenafil, there were both measured and patient-reported improvements in the left eye following after two months of sildenafil. CONCLUSIONS: Systemic phosphodiesterase (PDE)-5 and -6 inhibitors may facilitate the removal of lipid and waste from the subretinal space by increasing perfusion in patients with vitelliform lesions and aid in maintaining and/or recovering photoreceptor function.

Proton beam irradiation of uveal melanoma involving the iris, ciliary body and anterior choroid without surgical localisation (light field)

AimsTo assess treatment outcomes after proton beam irradiation (PBI) without surgical localisation of uveal melanomas involving the iris, ciliary body and anterior choroid.MethodsRetrospective chart review of 125 patients evaluated at...

Visual outcomes in diabetic macular edema patients after avastin injection

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.

The serious eye inflammation of post intraocular Avastin injection

Retrospective statistical study a collection of all patients with post intra vitreal injection (IVI) endophthalmitis in last 10 year period between 2010–2019 in eye department of Tobruk medical center -Tobruk and eye department of Alwahda hospital - Derna. We aim in this study to review the microbiology, clinical characteristics, diagnosis, and management strategies of post-intra vitreal injection endophthalmitis, by comparing our results with the different studies designs and treatment protocols. There were 9 patients of the after intra vitreal injections endophthalmitis cases. The age average is 70 years, 6 cases are females and 3 casees are male, all of them were practice post intravitreal Avastin injection endophthalmitis. There were 8 patients had Diabetes mellitus (DM), 2 patients had cardiovascular disease and 1 patient had hepatitis C as a systemic disease. The most common causative organism after intra vitreous injection endophthalmitis is Coagulase-negative staphylococci (CNS) 100% from the 56% positive causative organisms and 44% are no detected microorganisms, the outcome of cases which managed with pars-plana-vitrectomy (PPV) improved significantly about 60 Letters (&gt; 3 Lines) and cases managed without PPV &gt; 15 Letters (&gt; 3 Lines). The cases of post intraocular endophthalmitis which diagnosed and treated early with PPV give a good result and can save the vision. The cases of acute POE in the first 3 day had significant better function (P value = 0.02).