Intravitreal Bevacizumab In Patients Research Articles

Mean Best Corrected Visual Acuity after Intravitreal Bevacizumab in Patients with Diabetic Macular Edema

Purpose: To determine mean best corrected visual acuity after intravitreal bevacizumab in patients with diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Jinnah Hospital, Lahore and Chaudary Muhammad Akram Hospital Lahore from March 2018 to May 2021. Methods: A total of 200 patients of either gender with diabetic macular edema and age between 40 and 60 years were included in this study. Patients with dense cataract, corneal opacity, uncontrolled diabetes mellitus and those who were treated with pan retinal photocoagulation were excluded. Best corrected Visual Acuity (BCVA) was evaluated with Snellen chart and converted to log MAR. A standard protocol of 0.05 mL of Bevacizumab was prepared from injection Avastin, 100 mg/4 mL vial. Bevacizumab injection was given to all patients, using topical anesthesia, under aseptic measures in the operation theater. A total of 03 injections were given at 1-month interval. After three months, BCVA was recorded. Results were presented in number and percentages. Results: Mean age of the participants was 50.42 ± 6.48 years. Male to female ratio was 1:1.6, with 78 (39.0%) men and 122 (61.0%) women. Mean duration of diabetes mellitus was 5.12 ± 2.23 years. Mean pre-treatment BCVA was 0.51 ± 0.05 and mean post-treatment BCVA at three months was 0.26 ± 0.22. Conclusion: Mean BCVA is increased after intravitreal injection of Bevacizumab in patients with diabetic macular edema.

EVALUATING EFFICACY AND SAFETY OF SUPRACHOROIDAL TRIAMCINOLONE ACETONIDE FOR PATIENTS WITH RETINAL VEIN OCCLUSION

The prospective study was conducted in the Ophthalmology department, Sir Ganga Ram Hospital, Lahore, from January 2022 to January 2023 to compare the efficacy and safety of intravitreal (IVT) Bevacizumab alone with the suprachoroidal injection of CLS-TA (an injectable form of triamcinolone) along with IVT Bevacizumab in patients with retinal vein occlusion (RVO) induced macular edema in treatment naïve patients. Participants were randomized 1:1 to the IVT Bevacizumab group, and suprachoroidal injection of CLS-TA combined with IVT Bevacizumab group. Participants in both groups were administered drugs and monitored for 30 minutes after the injections. The final evaluation was done after 3 months. Results showed that the Bevacizumab group required 22 re-treatments of the participants for 3 months follow-up, while the combination group required 8 re-treatments (P=0.013). Regarding safety, 1 patient had cataract progression unrelated to the study drug. Combining steroids with vascular endothelial growth factor (VEGF) suppression benefits RVO-induced macular edema. It improves vision, reduces injection frequency, and provides rapid resolution. It is also seen that suprachoroidal delivery of CLS-TA is associated with a reduced risk of increased IOP and cataract progression compared to typical intraocular steroids. Regarding safety, 1 patient had cataract progression unrelated to the study drug. Combining steroids with vascular endothelial growth factor (VEGF) suppression benefits RVO-induced macular edema. It improves vision, reduces injection frequency, and provides rapid resolution. It is also seen that suprachoroidal delivery of CLS-TA is associated with a reduced risk of increased IOP and cataract progression compared to typical intraocular steroids.

Functional results in children with retinopathy of prematurity treated with intravitreal bevacizumab

Background/aimThe aim of the study is to describe the efficacy and to determine the functional outcome in terms of visual acuity and refractive defect of a single dose of intravitreal bevacizumab in patients with high-risk ROP type 1. MethodsIn this retrospective clinical study patients diagnosed between December 2013 and January 2018 with high-risk pre-threshold ROP type 1 and treated with intravitreal bevacizumab were selected. All patients were treated following the established protocol at our centre. Those patients with less than three-year follow-up were excluded. Visual acuity and cycloplegic refraction in the last visit were registered. Treatment efficacy was defined as the absence of retreatment with intravitreal anti-VEGF or laser during follow-up. ResultsA total of 38 infants (76 eyes) were included in the analysis. Twenty infants (40 eyes) completed visual acuity testing. Mean age was 6 years (IQR: 4–9). Median visual acuity was 0.8 (IQR: 0.5–1). Thirty-four eyes (85%) had good visual acuity (greater than or equal to 0.5). Thirty-seven patients (74 eyes) had cycloplegic refraction measured. Median spherical equivalent at the last visit was +0.94 (IQR: –0.25; 1.88). Treatment success rate was 96.05%. ConclusionIntravitreal bevacizumab treatment showed good functional outcome in patients with high-risk ROP type 1. In our study, good response to treatment was observed with a success rate over 95%.

Resultados funcionales de tratamiento con bevacizumab intravítreo en pacientes con retinopatía del prematuro

Background/aimThe aim of the study is to describe the efficacy and to determine the functional outcome in terms of visual acuity and refractive defect of a single dose of intravitreal bevacizumab in patients with high-risk ROP type1. MethodsIn this retrospective clinical study patients diagnosed between December 2013 and January 2018 with high-risk pre-threshold ROP type1 and treated with intravitreal bevacizumab were selected. All patients were treated following the established protocol at our centre. Those patients with less than three-year follow-up were excluded. Visual acuity and cycloplegic refraction in the last visit were registered. Treatment efficacy was defined as the absence of retreatment with intravitreal anti-VEGF or laser during follow-up. ResultsA total of 38 infants (76eyes) were included in the analysis. Twenty infants (40eyes) completed visual acuity testing. Mean age was 6years (IQR: 4-9). Median visual acuity was 0.8 (IQR: 0.5-1). Thirty-four eyes (85%) had good visual acuity (greater than or equal to 0.5). Thirty-seven patients (74eyes) had cycloplegic refraction measured. Median spherical equivalent at the last visit was +0.94 (IQR: −0.25; 1.88). Treatment success rate was 96.05%. ConclusionIntravitreal bevacizumab treatment showed good functional outcome in patients with high-risk ROP type1. In our study, good response to treatment was observed with a success rate over 95%.

Intra-ocular pressure changes after intravitreal injection of bevacizumab.

To evaluate the short-term and sustained intraocular pressure changes after intravitreal bevacizumab in patients with diabetic retinopathy. The quasi-experimental study was conducted at the District Headquarter Teaching Hospital, Gujranwala, Pakistan, from January to December 2020, and comprised diabetic patients of either gender aged 18-60 years with indication for intravitreal bevacizumab. Intraocular pressure was measured at 5, 10 and 30 minutes for short-term elevation, and the patients were followed up weekly for one month to record any sustained elevation in intraocular pressure. Data was analysed using SPSS 25. Of the 42 patients, 20(47.61%) were male and 22(52.38%) were female. The overall mean age was 52.4±5.7 years. Intraocular pressure increased significantly in the short term post-injection (p<0.001), while the difference was not significant in the weekly check-ups (p=0.264). There was short-term rise in intraocular pressure after intravitreal bevacizumab, but no sustained elevation was noted over the following month.

Factors affecting the visual outcomes and central macular thickness in diabetic maculopathy after intravitreal bevacizumab.

To assess the outcomes of intravitreal bevacizumab in patients of diabetic maculopathy by anatomical outcomes and best-corrected visual acuity, and to assess the prognostic factors that influence the efficacy of intravitreal bevacizumab. The quasi-experimental study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan, from January 2019 to January 2020, and comprised patients with diabetic maculopathy who were administered intravitreal bevacizumab on a monthly basis for three months with further injections administered on an as-needed basis in cases of persistent macular oedema or deterioration of best-corrected visual acuity. The assessment was done pre-injection, and three and six months after the injection. Outcome variables were best-corrected visual acuity and central macular thickness. Data was analysed using SPSS 22. Of the 34 patients, 2(5.9%) were males and 32(94.1%) were females. The overall mean age was 58±10 years. Of the 55 eyes, 27(49.1%) were right and 28(50.9%) were left eyes. After 3 months, the best-corrected visual acuity improved by one line in 20(36.4%) eyes. At 6 months, it improved by one line in 25(45.4%) eyes. After 3 months, the central macular thickness of 48(87.2%) eyes improved anatomically. At 6 months, a further decrease in central macular thickness resulted in 50(90.9%) eyes. The best-corrected visual acuity at 6 months was inversely correlated with central macular thickness and disruption of inner segment/outer segment integrity. Intravitreal bevacizumab injection led to appreciable improvement in best-corrected visual acuity and central macular thickness at 6 months. Disruption of inner segment/outer segment integrity, presence of exudates and cystic changes were noted that lead to poor visual prognosis.

Prophylaxis of Macular Edema with Preoperative Intravitreal Bevacizumab in Patients with Diabetic Retinopathy Undergoing Phacoemulsification

Purpose: To determine frequency of post-operative macular edema in diabetic retinopathy patients having received preoperative intravitreal bevacizumab, after phacoemulsification cataract surgery while compared with the controls. Study Design: Quasi experimental trial Place and Duration of Study: Department of ophthalmology eye unit 3, KEMU /Mayo hospital, Lahore from March 2020 to August 2020. Methods: A total of 60 patients were included in the study and randomly divided into two groups. Patients of study group were given 1.25mg bevacizumab injection by IV route two weeks priority to surgery while nothing was administered in the control group. Before one week of surgery ocular examination and OCT were perfumed and it was repeated after every month of performance of surgery. Allocation of patients was even not known to the researcher to avoid biasness. Components of monthly examination were best correct visual acuity, slit lamp examination and central macular thickness quantification with OCT. Standard cataract surgery was performed in all the patients (phacoemulsification and implantation of monofocal intraocular lens (IOL)). Post-operatively, all patients were given standard treatment i.e moxifloxacin-dexamethasone). Follow up of all the patients was made for consecutive three months on monthly basis to assess outcome variables i.e macular edema was observed keeping in view central macular thickness. Results: In patients of study group, 16.66% had developed macular edema while in control group it was observed in 46% patients. While comparing macular edema between side of eye, study group had 02 (13.33%) patients belonging to right eye while 03(20.0%) had left eye. However, in control group it was 08 (53.33%) and 06 (40.0%) for right and left eyes respectively. Group A had 230.23 ± 32.16 µm central macular thickness while it was 274.21 ± 25.34 µm in group B. Conclusion: In macular edema prophylaxis using preoperative intravitreal bevacizumab is efficacious in comparison with the controls in patients with mild-moderate edema. Keywords: NPDR, Macular edema, Intravitreal Bevacizumab, Phacoemulsification Surgery, Diabetic Retinopathy.

Add-On Effect of Simultaneous Intravitreal Dexamethasone to Intravitreal Bevacizumab in Patients with Macular Edema Secondary to Branch Retinal Vein Occlusion.

Purpose: To report the effect of simultaneous dexamethasone and bevacizumab combination treatment in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: Treatment-naive patients who had a macular edema secondary to BRVO with a duration of less than 1 month were treated either with intravitreal bevacizumab (Group-1) or intravitreal bevacizumab simultaneously combined with dexamethasone intravitreal implant (Group-2). In both groups, patients received monthly bevacizumab injection during the first 3 months. Between months 3 and 12, all patients were allowed to receive pro-re-nata bevacizumab. In Group-2, the first dexamethasone implant injection was simultaneously received with first bevacizumab injections. The patients were evaluated for re-treatment after 6 months and 11 months for second and third dexamethasone simultaneously with intravitreal bevacizumab. Results: In Group-1, 35 eyes of 35 patients and in Group-2, 32 eyes of 32 patients were treated. The mean gains in BCVA were +10.7 letters in the Group-1 and +21.3 letters in the Group-2 (P = 0.021) at month 12. The mean reduction in Central Macular Thickness (CMT) from the baseline were -173.74 μm in the Group-1 and -257.97 μm in the Group-2 (P = 0.0018). In Group-1, the mean intravitreal bevacizumab injection number was 7.18 ± 1.05. In Group-2, the mean intravitreal bevacizumab and dexamethasone injection number was 5.15 ± 1.24. There was a significant difference in mean injection numbers between 2 groups (P = 0.044). Conclusion: In the early period of macular edema adding dexamethasone to bevacizumab therapy does improve visual acuity and CMT, and reduce the injection frequency more than bevacizumab alone.

Topical ketorolac as an adjunctive treatment with intravitreal bevacizumab in the management of diabetic macular edema: A double-masked placebo-controlled randomized clinical trial.

To evaluate the additional effect of ketorolac eye drops on therapeutic effects of intravitreal Bevacizumab in patients with diabetic macular edema (DME) METHODS: In a randomized clinical trial, 50 patients with center involved DME (macular thickness ≥ 300 microns accompanied by decreased VA (24 < BCVA ≤ 70 ETDRS letters) were enrolled consecutively and randomized 1:1 to receive either bevacizumab plus topical ketorolac (25 patients) or bevacizumab plus artificial tears (25 patients). Patients with proliferative diabetic retinopathy, history of intraocular surgery, intravitreal injection in less than three months, macular photocoagulation less than 6months and any other concomitant ocular pathologies were excluded from the study. All the patients received three consecutive monthly injections of intravitreal bevacizumab (IVB). After that, patients were examined every 6weeks and reinjection was administered based on the "as needed" protocol if macular thickness was 300 microns or more and VA was 70 ETDRS letters or less.. Patients also received either topical ketorolac or artificial tears three times a day over the study period (6months). Changes in central subfield thickness (CST), best-corrected visual acuity (BCVA, ETDRS letters), and number of IVB injections were compared between the study groups. Fifty eyes of 50 patients were included (25 eyes in each group). Mean CST was significantly decreased in both study groups at 14th week (-87 ± 98µm, P = 0.012 and -100 ± 147µm, P = 0.006 in bevacizumab plus ketorolac and bevacizumab plus artificial tears groups, respectively). Nevertheless, the changes of mean CST remained significant only in bevacizumab plus ketorolac group up to 26th week (-147 ± 124µm, P < 0.001 and -51 ± 145µm, P = 0.245, respectively). Comparing two groups, reduction of mean CST from baseline was significantly greater in bevacizumab plus ketorolac group compared with the control group at 26th week. (difference = -97µm, 95%CI = -182 to -11, P = 0.017). In the study group, mean BCVA significantly increased at both 20th week (6.2 ± 10.1, P = 0.04) and 26th week (8.2 ± 10.9, P = 0.03). In contrast, visual acuity did not significantly improve at any time points in bevacizumab plus artificial tears group, While insignificant, the 26-week mean change of visual acuity from baseline was greater in bevacizumab plus ketorolac group (difference = 6.5 ETDRS letter; 95%CI = -14.4 to 1.4) Two groups were comparable regarding number of IVB injections (P = 0.99). Topical ketorolac 0.5% three times a day could enhance and sustain the efficacy of intravitreal bevacizumab in the treatment of DME.

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...

Outcomes of Intravitreal Bevacizumab in Patients with Diabetic Macular Edema at a Tertiary Hospital in Northern Tanzania

Background: Diabetic macular edema is a type of diabetic maculopathy affecting the central vision, ranging from mild blur to blindness. Laser photocoagulation has been the mainstay of treatment for the past three decades but it has a limited role in improving the central vision. Recent introduction of anti-vascular endothelial growth factors appears to be promising in restoring vision. However, due to its short half life multiple injections are required to control edema and maintain vision. Objectives: To determine the visual and anatomical outcomes of intravitreal bevacizumab in patients with diabetic macular edema.&#x0D; Methods: A hospital based retrospective cross-sectional study was done at Kilimanjaro Christian Medical Center eye department from 2011- 2015. During this time, patients with diabetic macular edema who were given intravitreal bevacizumab and satisfied the inclusion criteria were included in the study. Visual acuity, central macular thickness and macular volume were recorded at baseline, six, twelve, eighteen, twenty four and thirty weeks respectively. Optical coherence tomography was used to record central macular thickness and macular volume. Univariate and multivariate binary regression analysis were done and the p-value, odds ratio and 95% confidence interval were calculated.&#x0D; Results: The prevalence of Diabetic macular edema was 15.4%. Mean baseline visual acuity improved from 0.9 ± 0.57 log MAR (6/48) to 0.6±0.49 log MAR (6/24) (95% CI 0.207 - 0.389) at 30 weeks. The mean baseline central macular thickness decreased from 426.97 ± 148.358 μm to 280.98 ± 95.89 μm at 30 weeks (95% 151.531 - 187.044, P &lt; .001). The mean baseline macular volume decreased significantly from 10.59 ± 2.55 mm3 to 8.38 ± 1.498 mm3 (95% CI 1.860 - 2.886) at 30 weeks. In multivariate analysis, patients with no hypertension were more likely to have a better visual outcome of 6/18 or better (95% CI 1.064 - 4.420, P &lt; .033).&#x0D; Conclusion: This study shows a high burden of diabetic macular edema in our setting. Intravitreal bevacizumab injection results in better visual and anatomical outcomes.

Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma

Radiation retinopathy following plaque radiotherapy for uveal melanoma can lead to vision loss that might be avoided with prophylactic anti-vascular endothelial growth factor treatment. To determine visual outcome following prophylactic intravitreal bevacizumab in patients with plaque-irradiated uveal melanoma. Retrospective, nonrandomized, interventional cohort study at Wills Eye Hospital, Philadelphia, Pennsylvania. Prophylactic bevacizumab was administered between 2008 and 2018 to 1131 eyes with irradiated uveal melanoma (bevacizumab group) and compared with 117 eyes with irradiated uveal melanoma between 2007 and 2009 (no bevacizumab [historical control] group). Prophylactic intravitreal bevacizumab was provided at the time of plaque removal as well as 6 subsequent injections at 4-month intervals over 2 years. Visual acuity. The median patient age was 61 years, 1195 of 1248 patients were white (96%), and 632 of 1248 were women (51%). The median tumor thickness was 4.0 mm, and median distance to foveola was 3.0 mm. A difference was not identified (bevacizumab vs control group) in demographic features, clinical features, or radiation parameters. The mean follow-up was 40 months vs 56 months (mean difference, -18; 95% CI, -24 to -13; P < .001). By survival analysis, the bevacizumab group demonstrated less optical coherence tomography evidence of cystoid macular edema at 24 months (28% vs 37%; hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P = .02) and 36 months (44% vs 54%; HR, 1.5; 95% CI, 1.1-2.1; P = .01), less clinical evidence of radiation maculopathy at 24 months (27% vs 36%; HR, 1.5; 95% CI, 1.0-2.2; P = .03), 36 months (44% vs 55%; HR, 1.50; 95% CI, 1.1-2.0; P = .01), and 48 months (61% vs 66%; HR, 1.4; 95% CI, 1.0-1.9; P = .03), and less clinical evidence of radiation papillopathy at 18 months (6% vs 12%; HR, 2.0; 95% CI, 1.1-3.9; P = .04). Nonparametric analysis documented better visual acuity outcomes in the bevacizumab group at all points, including 12 months (median logMAR visual acuity [Snellen equivalent]: 0.30 [20/40] vs 0.48 [20/60]; mean difference, -0.28; 95% CI, -0.48 to -0.07; P = .02), 24 months (0.40 [20/50] vs 0.70 [20/100]; mean difference, -0.52; 95% CI, -0.75 to -0.29; P < .001), 36 months (0.48 [20/60] vs 1.00 [20/200]; mean difference, -0.49; 95% CI, -0.76 to -0.21; P = .003), and 48 months (0.54 [20/70] vs 2.00 [counting fingers]; mean difference, -0.71; 95% CI, -1.03 to -0.38; P < .001). These findings from a retrospective cohort of plaque radiotherapy and prophylactic intravitreal bevacizumab in patients with uveal melanoma suggest better visual outcomes when compared with nonrandomized historical control individuals through 4 years.

Microperimetry and OCT angiography evaluation of patients with ischemic diabetic macular edema treated with monthly intravitreal bevacizumab: a pilot study

BackgroundFunctional and anatomical evaluation of patients with ischemic diabetic macular edema after monthly injections of Bevacizumab.MethodsFive eyes from five patients with diabetic macular edema associated with macular ischemia in fluorescein angiography (FA), received 6 monthly intravitreal injections of Bevacizumab. All subjects underwent SD-OCT, FA, OCT angiography (OCTA) and microperimetry at baseline and after 6 months follow-up. Primary outcome measures were improvement of best corrected visual acuity (BCVA), microperimetry and assessment of macular perfusion (foveal avascular zone size and capillary loss).ResultsFive patients completed the follow-up. BCVA improved from 20/180 to 20/74 (p = 0.01) and macular sensitivity improved from 11.66 to 16.26 dB (p < 0.007). We also observed that areas of ischemia on OCTA represented areas of lower macular sensitivity on microperimetry. No changes in macular perfusion status were noted.ConclusionsMonthly intravitreal Bevacizumab in patients with ischemic diabetic macular edema improved BCVA and macular sensitivity without compromise of perfusion in the macula. Capillary dropout areas in OCTA correlated with lower retinal sensitivity on microperimetry.

Visual Outcomes of Pars Plana Vitrectomy Alone or with Intravitreal Bevacizumab in Patients of Diabetic Vitreous Haemorrhage.

To evaluate the visual outcomes of pars plana vitrectomy (PPV) alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. A quasi-experimental study. Al-Ibrahim Eye Hospital, Malir, Karachi, from March to November 2018. Patients between 40-70 years of age, irrespective of gender with non-resolving dense diabetic vitreous haemorrhage were divided into two groups. Group A received injection bevacizumab 7 days before PPV surgery. Group B received no preoperative injection. Log Mar chart was used for documenting postoperative vision. All patients completed their 6 months follow-up. SPSS was used to analyse the data. Best corrected visual acuity (BCVA) was documented as improved, same, or worse. In Group A, 21 (70%) patients had improved VA; whereas, in Group B, 17 (56.6%) patients showed improved visual acuity postoperatively. Patients were examined at four weeks, three months, and six months, respectively for recurrent vitreous haemorrhage. In Group A, 25 (83.3%) patients had no vitreous haemorrhage up to six months, whereas, in Group B, 13 (43.3%) patients had no vitreous haemorrhage up to six months with p-value of 0.021. Anti VEGF injection bevacizumab before PPV in patients with non-resolving diabetic vitreous haemorrhage is good to get better results in terms of BCVA, as well as reduce the incidence of recurrent vitreous haemorrhage.

Prophylaxis of Macular Edema with Peroperative Intravitreal Bevacizumab in Patients with Diabetic Retinopathy Undergoing Phacoemulsification

Purpose: To determine frequency of post-operative macular edema in patients with diabetic retinopathy receiving peroperative Intravitreal bevacizumab, as compared to controls after phacoemulsification cataract surgery.&#x0D; Study Design: Randomized control trial.&#x0D; Place and Duration of Study: Ophthalmology department holy family hospital Rawalpindi from July, 2016 to January, 2017.&#x0D; Materials and Methods: 60 patients who reported at the health care facility with diabetic retinopathy were included in the study. Out of these 30 were kept as control and 30 as cases. Data was collected and entered into SPSS version 19.0. Numerical variables were accounted for as mean and standard deviation whereas qualitative variables were accounted for as frequency and percentages. To compare the occurrence of macular edema at completion of 6 weeks in both study groups, Pearson’s chi-square test at 5% level of significance was applied. A p- value of 0.05 was considered as statistically significant. To control effect modifier by gender, and age, stratified analysis was also executed.&#x0D; Results: The participants of the study had mean age of 61.97 ± 5.7 years. Out of the 60 patients 33 (55%) were female. Analysis of both groups showed that macular edema was found in 4 (13.33%) patients in control group and 17 (56.67%) patients in group B. Most significant macular edema was seen in 11 patients in age group of 61-70 years. Gender wise stratification showed that 9 (56.5%) female patients reported with macular edema.&#x0D; Conclusion: Peroperative intravitreal bevacizumab is effective in prophylaxis of macular edema in patients with mild to moderate NPDR, as compared to controls,&#x0D; Keywords: NPDR, Intravitreal bevacizumab, Diabetic Retinopathy, Macular edema, Phacemulsification surgery.

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.

Comparison of structural outcome between intravitreal bevacizumab and laser treatment for type 1 retinopathy of prematurity after long-term follow-up

Background: To compare the structural outcome of intravitreal bevacizumab (IVB) and laser treatment for type 1 retinopathy of prematurity (ROP). Methods: This is a retrospective comparative study. From December 2002 to April 2009, patients with type 1 ROP according to criteria of Early Treatment of Retinopathy of Prematurity (ETROP) study were treated by peripheral retinal diode laser photocoagulation in nearly confluent pattern. From May 2009 to January 2015, we performed IVB for patients with type 1 ROP. The patients were closely followed until disappearance of retinal neovascularization in the laser group and regression of avascular zone in the bevacizumab group. The demographical data, postmenstrual age (PMA) for treatment, and fundus findings were recorded by chart review. The difference between laser and bevacizumab groups was compared by Student t-test and Fisher exact test. Results: We collected 43 patients (86 eyes) with type 1 ROP, including 30 male and 13 female infants. Their mean gestation age and birth body weight (BBW) were 27.5 weeks and 1,034 gm. Zone I and zone II disease were found in 8 and 35 patients. The mean PMA for treatment was 37.3 weeks. The mean follow-up period was 54.4 months. Laser treatment was administered in 26 patients, and bevacizumab injection for 17 infants. Single session of laser was performed in all patients of laser group without recurrence of retinal neovascularization. Complete regression of ROP was found in 15 infants of bevacizumab group following the first IVB. Four eyes in two patients (2/17, 11.7%) had recurrence of ROP and received additional injections and adjuvant laser treatment. There was no unfavorable anatomical results such as retinal detachment or macular ectopia or complications such as cataract or endophthalmitis in either bevacizumab or laser management. Conclusions: Laser therapy and IVB were both effective treatments for type 1 ROP to cause favorable anatomical outcomes. Single session of laser ablation in nearly confluent pattern was sufficient for complete regression of ROP in laser group. Single IVB was appropriate for managing most of cases with ROP in bevacizumab group, but a small proportion (nearly one tenth) of them had recurrent episodes requiring adjuvant therapies.

Intravitreal Bevacizumab and Cardiovascular Risk in Patients with Age-Related Macular Degeneration: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies.

Intravitreal bevacizumab (IVTB) is used to treat age-related macular degeneration (ARMD), although its use is off-label and its cardiovascular safety has not been unequivocally established. Our objective was to assess the cardiovascular safety of IVTB in patients with ARMD. We conducted a systematic review and meta-analysis of published randomized controlled trials (RCTs) and observational studies. Of the 2028 non-duplicate records, five RCTs versus ranibizumab (N=3038, 12/24months), four RCTs comparing different regimens (N=809, 12/23months), one RCT versus pegaptanib, photodynamic therapy (PDT), or sham (N=131, 12months), and three observational studies versus PDT, ranibizumab, or pegaptanib (~150,000 or 1666 patients/12months and 317 patients/1-2years, respectively) had a low risk of bias/high quality and ≥20 patients per arm with ≥6months and ≥3injections of treatment. RCT-based comparisons with PDT or pegaptanib are negligible. Observational data have not demonstrated differences [all-cause mortality, myocardial infarction (MI), stroke], but the level of evidence is "very low" (imprecise, indirect). RCT-based comparisons with ranibizumab did not demonstrate differences regarding some outcomes, although certain point estimates were at the level of a relevant harm/benefit [all-cause mortality odds ratio (OR) 1.103, 95% confidence interval (CI) 0.641-1.898; vascular mortality OR 1.380, 95% CI 0.476-3.997; MI OR 0.551, 95% CI 0.265-1.146; stroke OR 0.657, 95% CI 0.260-1.660; transitory ischemic attack OR 1.536, 95% CI 0.444-5.313; atherothrombotic events (ATEs) OR 1.007, 95% CI 0.641-1.593; venous thromboembolism OR 2.325, 95% CI 0.963-5.612] or suggested a higher risk with bevacizumab (hypertension OR 7.512, 95% CI 1.056-52.3), but estimates were based on sparse data, were extremely imprecise, and commonly exhibited considerable heterogeneity/inconsistency. The level of evidence per outcome was "low" or "very low". Observational data did not demonstrate difference (all-cause mortality, MI, stroke), or suggested a higher risk with bevacizumab (ATE), but were imprecise and indirect (level of evidence "very low"). RCT-based comparisons of different IVTB regimens suffered from the same limitations. Published data on IVTB in AMRD provide only a low level of evidence on its cardiovascular safety and do not support any finite conclusions.

The Effectiveness of Intravitreal Ranibizumab in Patients with Diabetic Macular Edema Who Have Failed to Respond to Intravitreal Bevacizumab

Purpose: To investigate the response to intravitreal ranibizumab after failure of intravitreal bevacizumab in patients with diabetic macular edema (DME). Methods: Demographics, visual acuity (VA), central macular thickness (CMT), and HbA_1C were retrospectively collected from DME patients treated with second-line intravitreal ranibizumab at a tertiary hospital in 2012-2013 and followed for at least 3 months. Results: Twenty-two patients (26 eyes) were included in the study, with a mean (±SD) age of 66 ± 8.1 years and followed for an average of 28.36 months. The mean number of intravitreal bevacizumab injections was 7.3 ± 2.8, and of intravitreal ranibizumab injections 5.11 ± 2.4. After 3 ranibizumab injections, 57% of eyes showed improvement in VA. The change in VA was statistically significant (p = 0.044) in those eyes where the pretreatment acuity for the second-line therapy was <20/40 (logMAR 0.3). CMT decreased from 435.95 ± 83.28 to 373.69 ± 44.39 µm (p = 0.01). The number of ranibizumab injections was significantly correlated with the change in CMT (p = 0.037). Conclusion: Intravitreal treatment with ranibizumab can be efficacious in eyes with DME that have failed to respond to bevacizumab.

Evaluation of effect of intravitreal injection bevacizumab in treatment of choroidal neovascualr membrane of the eye

Background: Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness in individuals over 50 years in developed countries. The objective was to study the effect of intravitreal bevacizumab in patients of choroidal neovascular membrane of eye by visual acuity and fluorescence angiography photograph. Methods: Non-randomized, open label, prospective analysis of 30 eyes in 30 patients with choroidal neovascualr diagnosed by direct ophthalmoscope and slit lamp 90D biomicroscopy. Visual acuity of the clinically diagnosed patient was taken by ETDRS (early treatment diabetic retinopathy system) visual acuity chart. Fundus fluorescence angiography was done by topcon retinal camera. Now all patients regardless of type were given 3 injections of 0.05 ml of injection bevacizumab intravitreally at infratemporal site 3.5 mm and 4 mm away from the limbus in pseudophakic and phakic eye repectively at interval of 1 month. After 1 month of last dose, patient was assessed with ETDRS chart for visual acuity, FFA for anatomical changes. FFA was done before and after giving 3 injection of bevacizumab at monthly interval. Patients were asked for regular follow-up and patients were examined after 6 hours, 48 hours and 7 days for any early and late complications. Results: There was significant improvement of visual acuity after intravitreal bevacizumab treatment (before 1.196 log MAR and after 0.95067 log MAR with p value is 0.0001, paired t-test with t=6.333 with 29 degree of freedom) in cases of choroidal neovascular membrane. Gain in visual acuity was accompanied by a significant decrease in leakage in fluorescein angiography (FFA) Conclusions: We present evidence that intravitreal bevacizumab is an effective treatment for choroidal neovascular membrane.