Intravitreal Application Of Bevacizumab Research Articles

Influence of vitreal reflux on intraocular pressure after intravitreal application of bevacizumab

Background/Aim: Intravitreal drug injection cause an increase in intraocular pressure (IOP). The increase in IOP is directly proportional to the volume of drug injected into the eye and inversely to the vitreal reflux. The mixture of fluid, presents as a subconjunctival bleb, composed of vitreous and injected drug is called vitreal reflux. In this study changes in IOP after intravitreal injection of bevacizumab in relation to the vitreous regurgitation were observed. Methods: This prospective study involved 50 patients (57 injections). Bevacizumab was administered intravitreally at a dose of 1.25 mg/0.05 mL. According to the type of disease, patients with diabetic macular oedema, proliferative diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, choroidal neovascularisation and central serous chorioretinopathy were included. They were divided into two groups - the first one without vitreal reflux and the second one with vitreal reflux. IOP values were measured at baseline, right after drug application and 20 min thereafter. Results: The reference value range of IOP values were 10-21 mmHg and so were the average baseline values in both experimental groups of patients (15.81 ± 3.50 mmHg). In the experimental group without reflux post application mean values of IOP at 0 and 20 min were 50 ± 9.65 and 18.54 ± 5.06 mmHg, respectively. In the experimental group with reflux post application mean IOP values after 0 and 20 min were 36 ± 8.68 mmHg and 18.91 ± 4.82 mmHg, respectively. Conclusions: Following intravitreal bevacizumab application, a significant increase in IOP occurs. After 20 minutes the IOP values spontaneously decreased below 25 mmHg in both groups and there was no significant difference in comparison with the baseline values. Vitreus reflux is a major factor in short-term post-injection IOP elevation, but not from the longer-term perspective.

Necrotizing enterocolitis after intravitreal bevacizumab in an infant with Incontinentia Pigmenti \u2013 a case report

BackgroundIncontinentia Pigmenti is a rare disease affecting multiple organs. Fifty of patients show affection of the eye with retinopathy and possible amaurosis being the worst outcome. Treatment has commonly been panretinal laser coagulation but intravitreal application of bevacizumab as VEGF-inhibitor has shown to effectively suppress retinal neovascularization.Case presentationA six-week-old female infant with Incontinentia Pigmenti developed a foudroyant necrotizing enterocolitis shortly after intravitreal injection of bevazicumab due to a retinopathy with impending tractional detachment of the left eye. Since the onset of abdominal symptoms occurred immediately after the intravitreal application, a link between the two events seemed likely. Sequential analyses of the VEGF serum concentrations showed a massive suppression of endogenous VEGF with only a very slow recovery over weeks. Such a severe systemic adverse event has not been reported after intravitreal treatment with bevacizumab in an infant.ConclusionThis case report shows a relevant systemic uptake of bevacizumab after intravitreal application as suppressed VEGF levels show. There seems to be a connection between suppressed VEGF levels and the onset of necrotizing enterocolitis. Therefore, treatment with bevacizumab should be carefully considered and further research is needed to assess this drug’s safety profile.

23-gauge pars plana vitrectomy surgery results of the cases with diabetic tractional retinal detachment

Amac: Diyabetik traksiyonel retina dekolman (TRD)’li hastalara uygulanan pars plana vitrektomi (PPV) sonuclarini ve komplikasyonlarini incelemek. Yontemler: Diyabetik TRD’si bulunan 193 hastanin 210 gozu calismaya dahil edildi. TRD nedeniyle 23-Gauge (G) PPV yapilan hastalarimizin dosyalari geriye donuk olarak incelendi. Tum hastalarin preoperatif ve postoperatif gorme keskinligi (GK), goz-ici basinc (GIB)’lari, biyomikroskopik muayeneleri, indirekt oftalmoskopla fundus muayeneleri, intraoperatif ve postoperatif komplikasyonlari, intraoperatif endotamponad kullanimi, postoperatif donemde gecirdikleri ameliyatlar kaydedildi. Bulgular: Calismaya alinan 193 hastanin 95’i erkek (%49,2), 98’i kadin (%50,8) olup cerrahi sirasindaki yas ortalamalari 56,01 ±10,91 yil idi. Hasta grubumuzun ortalama postoperatif takip suresi 18,47 ±14,06 (3-54) ay idi. 97 goze preoperatif intravitreal (IV) bevacizumab enjeksiyonu yapildi. Hastalarin preoperatif GK’leri ile postoperatif 1.,3.,6,12.,24.,36. ay ve son kontrollerdeki GK’leri karsilastirildiginda istatistiksel olarak anlamli bir artis goruldu (p≤0.001). Preoperatif GIB’lari ile postoperatif 1. gun, 1. ay, 6. ay, 12. ay ve hastalarin en son takiplerindeki GIB’leri arasinda istatistiksel olarak anlamli fark goruldu (p < 0.001). Preoperatif IV bevacizumab enjeksiyonu uygulanan hastalarla uygulanmayan hastalar arasinda postoperatif proliferatif diyabetik retinopati komplikasyonlari, intraoperatif hemoraji ve iyatrojenik retina yirtigi gelismesi acisindan istatistiksel olarak anlamli fark tespit edildi. Vakalarin 201 (%95)’inde anatomik basari, 165 (%78,5)’inde fonksiyonel basari saglandi. Sonuc: PPV diyabetik TRD’li hastalarda anatomik ve fonksiyonel basari saglamak acisindan oldukca etkili bir cerrahidir. Preoperatif IV bevacizumab uygulamasi da intraoperatif ve postoperatif komplikasyonlari azaltarak ameliyat suresini kisaltmada faydali bir tedavi yontemi olarak gorulmektedir.

Changes in the foveal microstructure after intravitreal bevacizumab application in patients with retinal vascular disease

PurposeTo investigate changes in the area of the foveal avascular zone (FAZ) in patients with retinal vascular disease.Patients and methodsThis retrospective, consecutive study examined 53 eyes of 53 patients with macular edema due to branch retinal vein occlusion in 25 patients (47.2%) and nonproliferative diabetic retinopathy in 28 patients (52.8%). The macular edema was treated with an intravitreal injection of 0.05 mL equal to 1.25 mg bevacizumab. Before and 6–8 weeks after the injection, best corrected visual acuity, slit lamp biomicroscopy of the anterior segment and fundus, optical coherence tomography, and fluorescein angiography were conducted. The FAZ was manually circumscribed on early-phase angiography images and the area of the FAZ was measured.ResultsThe preoperative overall mean FAZ area was 0.327 ± 0.126 mm2 (median 0.310 mm2). At the control consultation, the overall mean area was significantly larger (0.422 ± 0.259 mm2; median 0.380 mm2; P < 0.001). In the nonproliferative diabetic retinopathy subpopulation, the mean area was 0.361 ± 0.129 mm2 (median 0.330 mm2) before bevacizumab application and 0.434 mm2 at the follow-up visit (mean increase 0.071 mm2/19.7%). In the branch retinal vein occlusion group, the baseline FAZ area was 0.290 ± 0.115 mm2 and 0.407 ± 0.350 mm2 at follow-up (median 0.330 mm2; mean increase 0.117 mm2/40.3%). No cases of severe operation-associated complications were observed.ConclusionThe results confirm the safety of intravitreal bevacizumab injection in patients with macular edema due to nonproliferative diabetic retinopathy and branch retinal vein occlusion. The enlargement of the FAZ could be equivalent to an increase in retinal ischemia. These results may be transient; a potential vascular risk, however, when applying antivascular endothelial growth factor therapy in eyes with preexistent vascular disease must be considered.

INTRAVITREAL BEVACIZUMAB FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION

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

Comparison of UHR-OCT versus Stratus-OCT for definition of early retinal changes after intravitreal Bevacizumab (Avastin®) application in patients with AMD

PURPOSE: To investigate and demonstrate early structural changes of the retina/pigmentepithelial/choriocapillaris (RPECC) complex before and 10 ± 3 days after intravitreal application of bevacizumab (Avastin®) in patients with neovascular age related macular degeneration (nAMD) by comparison of standard Stratus Optical Coherence Tomography (S-OCT) and Ultra High Resolution (UHR-OCT) imaging systems. METHODS: Six patients with nAMD were examined in a consecutive case series with UHR-OCT and Stratus OCT one day before and 10 ± 3 days after intravitreal application of 1.25 mg (0.125 ml) bevacizumab (Avastin®). Maximum central retinal thickness (CRT) was measured with the retinal thickness program and calliper measuring function of S-OCT and by the measuring tool of Adobe Photoshop 5.0 in UHR-OCT pictures. RESULTS: In three of six cases residual fluid after treatment was only visible with UHR-OCT but not with the S-OCT. A decrease of maximum CRT could be shown in all cases in UHR-OCT pictures but only in half of the cases (6/3) in S-OCT pictures. In 2/6 cases vitreoretinal adhesions were demonstrable with UHR-OCT but not seen with the S-OCT, irregularities in the photoreceptor layer could be revealed clearly by UHR-OCT in 2/6 cases. CONCLUSION: After anti-VEGF treatment, UHR–OCT gives more accurate information about residual fluid and intraretinal damage than S-OCT and offers more precise measurements of maximum CRT. These factors may influence further decision of therapy and give us a better explanation and correlation with unsatisfactory visual acuities than with the S-OCT.

Suppression of Melanoma-Associated Neoangiogenesis by Bevacizumab

Bevacizumab, a potent antibody against the vascular endothelial growth factor (VEGF), has been shown to be effective for treatment of colorectal cancer. Recently, high effectiveness of bevacizumab in combination with paclitaxel has been reported in a single metastatic melanoma case. To our knowledge, we demonstrate for the first time the antiangiogenetic effect of bevacizumab in a patient with a vitreous melanoma metastasis. A 68-year-old man with a vitreous melanoma metastasis of the left eye was treated with a revitrectomy combined with intravitreal bevacizumab application because of iris neovascularization and progressive epiretinal tumor plaques. Four days after the treatment, the melanoma-associated neovascularization completely disappeared, but it recurred after 6 weeks. Although repetitive administration of local bevacizumab produced the same antiangiogenetic effect, progression of the epiretinal tumor plaques could not be stopped with the local bevacizumab treatment. Intraocular administration of the anti-VEGF drug bevacizumab causes immediate and complete regression of melanoma-associated angiogenesis. The rationale for the therapeutic strategy in our patient was an elevated level of VEGF in the vitreous cavity. Because we could not demonstrate a direct antiproliferative effect of bevacizumab on melanoma metastasis, bevacizumab seems most promising if evaluated in combination with antiproliferative agents.