Intravitreal Administration Of Bevacizumab Research Articles

Intra-operative Intravitreal Bevacizumab For Patients With Diabetic Macular Edema Undergoing Phacoemulsification with Foldable IOL Implantation

Objective: To assess the efficacy of Intra-operative Intravitreal Bevacizumab in treating Diabetic Macular Edema in patients undergoing Phacoemulsification with Foldable intraocular lens (IOL) Implantation, in comparison to a control group.Methodology: This experimental study was performed in department of Ophthalmology, Madinah Teaching Hospital, Faisalabad from 5th October to 2022 – 5th March 2023. Sixty patients (30 in each group) were enrolled in the study. Patients in group “A” received Intravitreal Bevacizumab immediately after phacoemulsification with foldable IOL implantation.Whereas Intravitreal Bevacizumab was not given to patients in group B (control group). Best Corrected Visual Acuity (BCVA) and macular thickness using optical coherence tomography (OCT) were recorded within a timeframe of 7-30 days prior to surgery, as well as at 1 and 3 months after the surgery for comparison between the two study groups. Results: The study comprised 60 patients, with a mean age of 56.43 ± 5.90 years, representing both genders. Among the participants, males were predominant, accounting for 32 (53.3%) individuals, while females constituted 28 (46.7%) of the sample. The baseline best-corrected visual acuity (BCVA) measurements between group A and group B were 0.22 ± 0.68 and 0.21 ± 0.07, respectively. There was no statistically significant difference observed between the two groups (P = 0.677). However, significant disparities in BCVA were observed after one- and three-months post-surgery, favoring group A.Similarly, mean optical coherence tomography (OCT) at baseline was 271.09 ± 26.87 in group A and 307.57 ± 32.81 in group B, with no significant difference (P = 0.771). Nonetheless, significant differences in OCT were noted after one- and three-months post-surgery, with group A demonstrating superior results. These findings underscore the beneficial impact of intra-operative Bevacizumab in improving both BCVA and OCT outcomes post-surgery. Conclusion: The administration of intravitreal bevacizumab during phacoemulsification has been shown to yield notable improvements in Best Corrected Visual Acuity (BVCA) and Optical Coherence Tomography (OCT) among those with diabetes with macular edema who are undergoing cataract surgery.

EFFECT OF TOPICAL SODIUM DICLOFENAC AS ADJUVANT TO INTRAVITREAL BEVACIZUMAB INJECTION THERAPY ON VISUAL ACUITY INTRAOCULAR PRESSURE CHANGES IN PATIENTS WITH DIABETIC MACULAR EDEMA

Introduction dan Aim: Diabetic Macular Edema (DME) in Diabetic Retinopathy (DR) patients might threaten the patient's visual acuity. Therefore, a robust DME treatment is needed to prevent sight threatening condition in DR patients. In this study, we intended to compare the effects of intravitreal administration of bevacizumab versus bevacizumab and topical natrium diclofenac in DR patients who developed DME. Methods: This was a randomized controlled trial study with double blinds. Data were taken from April 2020 to June 2021 from the Dr. Sardjito Central General Hospital and the Dr. Suhardi Hardjolukito Indonesian Air Force Central Hospital, Yogyakarta. Our patients were assigned to a control group (intravitreal bevacizumab therapy only) and an intervention group (intravitreal bevacizumab and topical natrium diclofenac). Then, we evaluated best corrected visual acuity (LogMar) and intraocular pressure (IOP, mmHg) were recorded in both groups before and after therapy. Results: A total of 38 eyes from 36 patients with naive DME were included in this study. Both treatment groups showed a statistically significant improvement in visual acuity after treatment bevacizumab (pre = 0.8±0.5; post = 0.6±0.5; p-value = 0.033) and bevacizumab and natrium diclofenac (pre = 0.9±0.5; post = 0.5±0.3; p-value = 0.004). In contrast to the above findings, the IOP in both groups did not show a significant change in IOP after therapy, bevacizumab (pre = 15.7±4.1; post = 15.6±4.2; p-value = 0.810) and bevacizumab and natrium diclofenac (pre = 16.0±4.5; post = 16.0±3.9; p-value = 0.868). Conclusion: Our study showed that visual acuity was improved significantly in DME patients treated with either bevacizumab or bevacizumab and natrium diclofenac. This might be a valuable information on the improvement of DME therapy, given that no increased post-therapy IOP in patients treated topical natrium diclofenac.

Evaluation of babies with retinopathy of prematurity following intravitreal bevacizumab administration.

In Turkiye, the increased likelihood of survival of small premature babies has resulted in a higher incidence of retinopathy of prematurity (ROP), which causes severe visual impairment in childhood. Early diagnosis and timely and proper treatment of ROP can prevent vision loss. This paper discusses cases of ROP treated with bevacizumab. Patients treated with bevacizumab for ROP were evaluated retrospectively. Systolic and diastolic blood pressure values were recorded 1 day before and 2 weeks after bevacizumab administration. The Bayley III test, hearing test, eye examination, and neurological evaluation were performed. The mean composite Bayley III test scores for cognition, language, motor, social-emotional, and adaptive domains in 10 patients who received bevacizumab for ROP were 75±10.8, 73.4±15.4, 71.2±10.2, 88±23.7, and 65.4±13.8, respectively. The mean values of the day before the injection and the values of the 14 days after the injection were compared, it was seen that there was a significant increase in systolic blood pressure values, especially at the end of 1st day and 1st week after the surgery. Neurological examination results were abnormal in 50% of the cases. Vision problems were detected in 40% of the cases. About 30% of the babies failed the hearing test. Caution needs attention in the care of neonates until further studies of the long-term benefits and effects of bevacizumab therapy are completed.

COMPARISON OF VISUAL ACUITY OUTCOME IN PROLIFERATIVE DIABETIC RETINOPATHY(PDR) BETWEEN INTRAVITREAL BEVACIZUMAB AND RANIBIZUMAB INJECTIONS

PURPOSE: Diabetic Retinopathy is one of the worst complications of diabetes and can threaten sight. The aim of this study is to compare the visual acuity outcome in proliferative diabetic retinopathy(PDR) with clinically detectable macular oedema after intravitreal administration of either bevacizumab or ranibizumab. METHOD: Data were analysed retrospectively in which 80 eyes of 64 patients were enrolled. They were divided into two groups by simple random sampling, 40 PDR eyes treated with bevacizumab in group A and 40 PDR eyes treated with ranibizumab in group B. Visual acuities along with basic demographic characteristics were noted down. The changes in best corrected vision(BCVA) and the number of injections required were compared between the two groups. RESULTS: The study included 80 eyes of 64 patients, out of which 52 were phakic and 28 were pseudophakic. At the end of 1 year, in Group A 10 eyes(25%) showed no changes in visual acuity, 29 eyes(72.5%) showed improvement between LogMAR 1.00 to 0.48 and 1(2.5%) showed visual acuity less than LogMAR 0.33. In Group B, 8 eyes(20%) showed no changes, 30 eyes(75%) showed improvement between LogMAR 1.00 to 0.48, 2 eye(5%) showed visual acuity less than LogMAR 0.33 Group A and Group B showed similar efcacy after same number of intravitreal injections administered and similar follow-up.CONCLUSION: Our results show that ranibizumab and bevacizumab are more or less similar in terms of visual acuity outcome. At the same time bevacizumab is more cost-effective than ranibizumab. Further trials needs to be done using bevacizumab. The success of anti-VEGF treatment depends not only on the treatment of active disease, but also on the prevention of disease of disease worsening. Planning the next anti-VEGF injection treatment helps to minimize the possibility of delays in treatment. The present covid-19 lockdown restrictions has affected in the treatment causing delay.

Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy

Introduction: The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR). Methods: This retrospective comparative study was performed on 118 eyes (118 patients) with proliferative diabetic retinopathy (PDR), which underwent vitrectomy surgery at the Department of Diabetic Eye Disease at Zarifa Aliyeva National Ophthalmology Centre (Baku, Azerbaijan) in 2015-2019. The main group (the bevacizumab group) included 48 eyes with PDR that received intravitreal administration of bevacizumab (Avastin; Genentech Inc., USA) within one week before vitrectomy; the control group included 70 eyes that did not receive a bevacizumab injection for at least 3 months before the vitrectomy. The minimum follow-up was 12 months. Results: In both groups, complete retinal attachment after primary vitrectomy was achieved in all eyes (100%). Clinically significant intraoperative haemorrhage was observed in the preoperative bevacizumab injection group in 31.2% and the control group- 51.4%, p = 0.030. The preoperative bevacizumab injection reduced the risk of clinically significant haemorrhage by 2.3 times and the need for endodiathermy by 2.7 times (p = 0.031 and p = 0.024, respectively). Early vitreous cavity haemorrhage was observed in 15.0% in the bevacizumab group and in 35.5% in the control group (p = 0.038). The preoperative injection of bevacizumab before vitrectomy reduced the risk of vitreous cavity haemorrhage in the early postoperative period by 3.0 times (p = 0.036). Conclusion: The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period. Over the long-term follow-up period, the effect of the preoperative bevacizumab injections decreases.

Association of Systemic or Intravitreal Antivascular Endothelial Growth Factor (Anti-VEGF) and Impaired Wound Healing in Pediatric Patients: Collagen to the Rescue.

Bevacizumab is a humanized monoclonal antibody to vascular endothelial growth factor (VEGF) that has been used as a systemic chemotherapy treatment of various malignancies in adults since 2000. It has been used for pediatric patients over the last decade. In addition, bevacizumab is used for neonatal intravitreal administration for retinopathy of prematurity, a major complication of preterm birth, characterized by incomplete and abnormal vascularization of the retina that can lead to retinal detachment and blindness without treatment. The objective of this multiple case series is to report impaired wound healing seen in 3 adolescents and 1 premature neonate receiving bevacizumab and to propose collagen-based dermal template as a choice for the management of such wounds. The 3 adolescents were undergoing treatment of malignancies and developed wound healing complication within weeks of receiving anti-VEGF. The premature neonate experienced an extravasation and had a slow wound healing trajectory after receiving intravitreal administration of bevacizumab for retinopathy of prematurity. All wounds achieved closure following topical treatment with a collagen dermal template. Use of bevacizumab is increasing in the pediatric population. Clinicians should be aware of compromised wound healing and higher likelihood of wound dehiscence after bevacizumab administration. We recommend waiting for at least 4 to 6 weeks between anti-VEGF administration (either systemic or vitreous) and elective surgical procedures, consistent with adult literature recommendations. If patient has an existing wound, we assert that bevacizumab should not be administered until that wound is healed. If wound healing is stalled, we recommend dermal template as a safe and effective accelerator of wound healing.

Clinical management of an outbreak of nutritionally variant streptococcus endophthalmitis following intravitreal bevacizumab injection

BackgroundThe management of an outbreak of endophthalmitis associated with intravitreal bevacizumab represents a challenging real-time process involving identification of cases, treatment and mitigation measures during the outbreak. We summarize the clinical presentation and management of a cluster of endophthalmitis cases from contaminated bevacizumab, in addition to mathematical probabilistic assessment of the number of cases that define an outbreak.MethodsA retrospective study was conducted to assess the management of an endophthalmitis outbreak after intravitreal bevacizumab (IVB) administration. Demographic data, clinical information, individual patient management and public health reporting measures were reviewed. Outcomes of patients who received prophylactic antibiotics for endophthalmitis prevention were also reviewed. Binomial tail probability calculations were performed to determine the likelihood of clusters of endophthalmitis that could inform when an outbreak was evolving that would warrant more public health notification measures and communication.ResultsForty-five eyes of 42 patients who received IVB from a single batch were reviewed. Four cases of endophthalmitis from Granulicatella adiacens, a nutritionally-variant Streptococcus species, were treated successfully with intravitreal antibiotics ± vitrectomy. Thirty-four of the remaining 41 eyes were treated with prophylactic intravitreal vancomycin with no additional cases of endophthalmitis. Outbreak management also included CDC, ASRS and public health authority notification. Binominal tail probabilities demonstrated the rarity of clusters from a single batch (i.e. ~ 1/10,000 for 2 cases; 1/2 million for 3 cases). However, given the U.S. scale of IVB administration, there is an 87% chance of a cluster ≧ 2 and a 1% chance of a cluster ≧ 3 cases annually, which may guide outbreak management. A process diagram was developed to incorporate patient management and public health measures when an outbreak is suspected.ConclusionIntravitreal antibiotics and vitrectomy were effective in the individual management of cases of endophthalmitis, and no serious adverse events occurred with prophylactic intravitreal vancomycin for at-risk eyes. Best practices for outbreaks should be evaluated, given their likelihood within the U.S. and the sight-threatening consequences of endophthalmitis.

Trabeculectomy in patients with diabetes: subconjunctival Mitomycin C with or without intravitreal bevacizumab

Background/aimsTo evaluate the success of Mitomycin C (MMC) augmented trabeculectomy with or without intravitreal bevacizumab in patients with diabetes without neovascular glaucoma.MethodsFifty-six patients with diabetes who needed trabeculectomy were randomised...

Safety and clinical effectiveness of intravitreal administration of bevacizumab (Lumiere®) in patients with neovascular age-related macular degeneration.

The present study was an open-label, prospective, uncontrolled and multicenter clinical trial to investigate the safety and effectiveness of bevacizumab (Lumiere®) administered by the intravitreal route for the treatment of neovascular age-related macular degeneration (nAMD). A total of 22 patients without previous treatment with anti-vascular endothelial growth factor were recruited. Monthly therapy with 1.25 mg intravitreal bevacizumab was applied. Adverse events (AE), visual acuity (VA) and central retinal thickness (CRT) were assessed at baseline, day 1 and day 28 after each injection. A total of 87 AEs were reported; most of them were not serious (96.6%), expected (65.5%) and occurred after the third injection (56.3%). The most frequent AE was ‘conjunctival hemorrhage’ (29.9% of AEs), attributed to the injection procedure. Treatment was not suspended due to safety reasons in any case. After six months, a statistically significant gain of +8.2 (SD±8.8) letters and a CRT reduction of -75.50 µm (SD±120.3) were achieved with unilateral therapy. VA improvement and CRT reduction were also achieved with bilateral therapy, although to a lesser extent. The results of the present study suggested that therapy with a minimum of 3 doses of bevacizumab over a 6-month period was well tolerated and resulted in a sustained response regarding VA improvement and CRT reduction from the beginning of therapy compared with the baseline value. The study protocol was registered at clinicaltrials.gov (ref. no. NCT03668054).

Bevacizumab in Retinopathy of Prematurity : Concerns and adverse effects.

Retinopathy of prematurity (ROP) ranks as one of the leading causes of blindness in the paediatric age group, the incidence of which is increasing in developing countries as the economy strengthens and healthcare practices improve. As a vasoproliferative disorder affecting premature neonates VEGF is said to play a vital role in the pathogenesis of ROP. Evidence of the efficacy of anti-VEGF agents in treatment of ROP have been seen in literature since early 2007 with most published reports being either case studies or small case series. The only randomised controlled trial in this regard was the BEAT-ROP study which was published in 2011. However, even in that study the adverse effects of Bevacizumab were not analysed. This review aims to discuss the complications prior to the blanket administration of intravitreal bevacizumab in the management of ROP.

Macular microvascular changes after intravitreal bevacizumab injection in diabetic macular edema

ObjectiveTo evaluate the changes in retinal capillary plexus and the choriocapillaris after a single intravitreal injection of bevacizumab in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). DesignProspective interventional case series. ParticipantsPatients having diabetes with centre-involving diabetic macular edema. MethodsIn this prospective interventional case series, eyes with centre-involving diabetic macular edema were enrolled. Vascular density (VD), vascular diameter index (VDI), vascular length density (VLD), foveal avascular zone (FAZ) area, and foveal density (FD)-300 were measured using en face OCTA images before and 1 month after administration of intravitreal bevacizumab. VD and VDI measurements were performed in the superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP) and in the choriocapillaris. Additionally, capillary nonperfusion area (CNPA) was detected automatically based on vessel distance map in 4 concentric rings around the foveal centre. The segmentation error was manually corrected, and the measurements were performed by 2 expert graders. ResultsTwenty-three eyes of 19 patients with a mean age of 62.76 ± 6.88 years were included. There were no significant changes in the FAZ area, FD-300, or in the VD of the foveal and parafoveal SCP and DCP. Also, VLD and VDI of the SCP and DCP remained unchanged. The change in the CNPA was not statistically significant. The VD of choriocapillaris increased significantly after injections (p = 0.005). ConclusionsFAZ area and VD of the retinal capillary plexus remained stable in the short-term period after intravitreal bevacizumab. In addition, the choriocapillaris blood flow improved after bevacizumab injection.

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.

Off-label use of bevacizumab for wet age-related macular degeneration in Europe

PurposeTo analyse current off-label use of bevacizumab for wet age-related macular degeneration (AMD) in Europe.MethodsThe study was conducted as a combined survey and literature review. It included the 22 most populous countries in Europe. In each country, ophthalmologists with particular knowledge about off-label treatment responded to a questionnaire.ResultsAnswers were obtained from twenty European countries. The off-label use of bevacizumab for wet AMD greatly differed between nations; the bevacizumab proportion varied from non-existent (0%) to very high (97%). There were also large disparities within single countries (e.g. 0–80%), which were attributable to differences in regional decision-making. Both governmental institutions and national ophthalmological societies expressed highly diverging opinions on the use of off-label treatment. Intravitreal administration of bevacizumab had been a matter of legal dispute in several countries. The question about responsibility for off-label therapy mainly remained unanswered.ConclusionsThere was a highly varying utilization of bevacizumab between European countries. Despite an intention of a consistent approach to medical regulations, Europe has not yet reached a professional or political consensus on the ophthalmic off-label use of bevacizumab.

Prospective evaluation of intravitreal bevacizumab for ischemic central retinal vein occlusion

BackgroundAlthough previous studies have evaluated the effect of anti-VEGF therapies for central retinal vein occlusion (CRVO) patients, the majority of previous studies have excluded or included a very small number of patients with ischemic CRVO (iCRVO). The aim of our study is to examine the effects of bevacizumab on macular edema secondary to ischemic central retinal vein occlusion, as well as the effects on central choroidal thickness and best-corrected visual acuity.MethodsIn this prospective, interventional case series, iCRVO was defined by the presence of ≥ 10 or more disc diameter areas of retinal nonperfusion by fluorescein angiography (FA) and by the presence of a b/a ratio less than 1.5 by full-field electroretinogram (ffERG). Nine eyes with iCRVO received monthly bevacizumab 0.5 mg injections at baseline and months 1 to 5 for a maximum of six injections. Main outcome measures were visual acuity (Snellen), central foveal thickness, and central choroidal thickness as measured by Spectral-Domain Optical Coherence Tomography (SD-OCT) at baseline and at 6 month following initial intravitreal bevacizumab injection. Pairwise t-tests and the Wilcoxon signed-rank test were conducted to compare the outcome measures.ResultsAfter intravitreal administration of bevacizumab, there was a significant reduction of central foveal thickness from 858 ± 311 μm at baseline to 243 ± 106 μm at the 6-month follow-up, as well as a significant reduction of central choroidal thickness from 282 ± 38 μm at baseline to 227 ± 56 μm at the 6-month follow-up (p = 0.0006, p = 0.0003 respectively). The visual acuity worsened from a median of 1.3 to 1.7 (p = 0.02).ConclusionIn patients with iCRVO, intravitreal bevacizumab led to a reduction of central macular edema and central choroidal thickness, but a worsening of visual acuity. Intravitreal bevacizumab reduces macular edema but is not able to overcome the poor prognosis of iCRVO.

Intravitreal bevacizumab administration for the treatment of chronic central serous chorioretinopathy

PurposeTo evaluate the effects of intravitreal bevacizumab (IVB) injection on chronic central serous chorioretinopathy (CSC). MethodsIn this prospective interventional case series, a total of 22 eyes of 22 patients, diagnosed with unresolved CSC for three months or longer, received 1.25 mg IVB injection. Also, in case of failure to achieve success parameters, double dose IVB injections continued in order to reach the complete subretinal fluid (SRF) absorption. A complete ophthalmic assessment was carried out one day, one week, and one-month post-injection, and then a monthly visit was performed, and re-injection was done if needed. Visual acuity, subretinal space volume (SSV), central macular thickness (CMT), and contrast sensitivity were measured and compared among baseline values and final post-treatment values. ResultsThe mean best corrected visual acuity increased significantly from 0.70 ± 0.22 to 0.17 ± 0.15 logMAR (P <0.001), and the CMT showed a significant reduction from 557.36 ± 129.12 to 259.50 ± 116.73 μm (P <0.001 ). In addition, SSV decreased significantly from 10.53 ± 2.03 to 6.63 ± 1.80 (P = 0.001), and contrast sensitivity improved significantly from 13.8182 ± 2.64820 dB to 17.6818 ± 1.80967 dB (P <0.001). ConclusionIn this series, SRF absorption occurred and visual acuity improved after IVB injections, however, further comparative studies are needed to show the effect of IVB in chronic CSC.

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

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

TWELVE-MONTH EFFICACY OF INTRAVITREAL BEVACIZUMAB INJECTION FOR CHRONIC, ATYPICAL, OR RECURRENT CENTRAL SEROUS CHORIORETINOPATHY.

To evaluate intravitreal bevacizumab (IVB) injection efficacy for the treatment of chronic, atypical, or recurrent central serous chorioretinopathy (CSC). Clinical data from 77 eyes of 71 patients with chronic, atypical, or recurrent CSC treated with IVB were retrospectively analyzed. After initial 6-weekly IVB administration until no subretinal fluid remained at the fovea, additional as-needed IVBs were administered, based on optical coherence tomography findings. Best-corrected visual acuity and central retinal thickness (CRT) were analyzed at baseline and 3, 6, 9, and 12 months after initial IVB. The significant improvement of baseline logarithm of minimum angle of resolution best-corrected visual acuity and CRT at 3 months (both P < 0.001) was maintained throughout the 12-month follow-up period. Best-corrected visual acuity improved significantly in patients with chronic and recurrent CSC, at all time points (all P < 0.05), but not in patients with atypical CSC. The CRT reduction was significant in all subgroups during the follow-up period (all P < 0.05). Definite leakage on initial fluorescein angiography correlated with improved reduction in CRT (P = 0.039). As-needed optical coherence tomography-based IVB was effective for reducing CRT in patients with chronic, atypical, or recurrent CSC, and for vision improvement in chronic and recurrent CSC over the 1-year follow-up period.

Bevacizumab before Diabetic Vitrectomy: A Clinical Trial Assessing 3 Dosing Amounts

To evaluate the optimal dosing of preoperative intravitreal bevacizumab (IVB) in patients undergoing pars plana vitrectomy (PPV) for manifestations of proliferative diabetic retinopathy (PDR). Randomized clinical trial. Two hundred six patients with severe manifestations of PDR underwent PPV at a single university-based hospital. Patients were randomized into 1 of 3 treatment groups: group A received 0.625 mg IVB (0.025 ml) 1 to 10 days before PPV, group B received 1.25 mg IVB (0.05 ml) 1 to 10 days before PPV, and group C received 2.5 mg IVB (0.1 ml) 1 to 10 days before PPV. The primary outcome was best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures were rates of perioperative tractional retinal detachment (TRD) development, intraoperative and postoperative complications, and incidence of unplanned PPV at 6 months. One hundred sixty-seven patients underwent PPV and completed 6 months of follow-up. There were no significant differences between treatment groups regarding baseline characteristics, final BCVA, intraoperative complications, postoperative complications, or unplanned PPV rates. There were no patients in group A(0.0%), 3 patients in group B (7.0%), and 5 patients in group C (8.5%) who demonstrated perioperative TRD after IVB administration, but before PPV (P= 0.0283). This difference was significant between groups A and B (P= 0.0494) and between groups A and C (P= 0.0080). This randomized clinical trial demonstrated that patients receiving the 0.625-mg dose of IVB before PPV for the treatment of PDR-related manifestations showed similar visual acuity, but a lower incidence of perioperative TRD development compared with patients receiving the 1.25-mg and 2.5-mg doses. Clinicians should consider adopting the lowest effective dose, 0.625 mg, into clinical practice. The current study is limited by the lack of a control group receiving no IVB before PPV.

Systemic side effects after intravitreal administration of antivascular endothelial growth factors for neovascular age-related macular degeneration

Age-related macular degeneration is a chronic and progressive disease of the retina that occurs with increasing frequency with age, representing the leading cause of irreversible blindness in patients over 50 years of age. The loss of visual perception occurs due to neovascular proliferation. Antivascular endothelial growth factors revolutionized the treatment of exudative age-related macular degeneration. Our aim was to assess the systemic safety of intravitreal administration of ranibizumab, bevacizumab, or aflibercept in patients with neovascular age-related macular degeneration. The study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The primary outcomes included: all-cause death and all serious systemic adverse events. We calculated the incidence of systemic adverse events, relative risk of the outcomes, and 95% confidence intervals. This review included representative outcome data on 12,292 participants from 24 trials, which included both men and women aged 50 years or older with neovascular age-related macular degeneration. In bevacizumab-treated patients, the most frequent systemic adverse event in our analysis was nonocular hemorrhage. In ranibizumab-treated patients, systemic adverse events were not dose-dependent. The number of systemic adverse events was similar in patients treated with ranibizumab (4.73%) or with aflibercept (4.76%). This meta-analysis did not find any statistically significant difference regarding the occurrence of death or other serious systemic adverse events such as treatment-emergent hypertension, myocardial infarction, stroke, or nonocular hemorrhage after intravitreal use of antivascular endothelial growth factors.

Intravitreal bevacizumab administration for complicated retinal arterial macroaneurysm in a young male patient

PurposeRetinal arterial macro aneurysms (RAM) represent aquired retinal vascular disorders encountered predominantly in elderly, with marked female predominance, and most often associated with hypertension, arteriosclerosis and cardiovascular disease.In this poster we try to assess functional and anatomical results after bevacizumab (Avastin) injection in a young male with complicated RAM.MethodsA 27 years old male presented in our clinic with decreased visual acuity into the right eye with the debut 10 days before. The patient underwent a comprehensive ophthalmologic and OCT examination. The diagnosis of retinal arterial macroaneurysm complicated with macular edema associated with lipoprotein exsudation was established. The patient underwent intravitreal injection of bevacizumab (Avastin) 1.25 mg/0.05 ml; two follow‐up visits were planned at 1 and 4 weeks after bevacizumab intravitreal administration.ResultsAt 4 weeks after intravitreal bevacizumab, right eye BCVA improved from 0.17 logMAR to 0.1 logMAR; the retinal hemorrhage reduced considerable, retinophotography demonstrated resolution of the exsudative changes and OCT examination showed physiologic appearance of the fovea. The patient underwent thorough investigations in cardiovascular area, including cerebral MRI. He was also proposed for retinal angiofluorography.ConclusionsAlthough many patients are asymptomatic, decreased visual acuity is the most frequent symptom, and it is determined by hemorrhage and/or macular edema with macular star formation. The differential diagnosis of RAM includes retinal and systemic diseases that require thorough investigation.