Intravitreal Bevacizumab Injection Research Articles

Risk Factors for Aggravation of Myopic Retinoschisis after Intravitreal Bevacizumab Injection in Myopic Choroidal Neovascularization

Risk Factors for Aggravation of Myopic Retinoschisis after Intravitreal Bevacizumab Injection in Myopic Choroidal Neovascularization

The Predictors of Early Treatment Effectiveness of Intravitreal Bevacizumab Application in Patients with Diabetic Macular Edema

The aim of this study was to establish whether multiple blood parameters might predict an early treatment response to intravitreal bevacizumab injections in patients with diabetic macular edema (DME). Seventy-eight patients with non-proliferative diabetic retinopathy (NPDR) and DME were included. The treatment response was evaluated with central macular thickness decrease and best corrected visual acuity increase one month after the last bevacizumab injection. Parameters of interest were the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), vitamin D, and apolipoprotein B to A-I ratio (ApoB/ApoA-I). The NLR (2.03 ± 0.70 vs. 2.80 ± 1.08; p < 0.001), MLR (0.23 ± 0.06 vs. 0.28 ± 0.10; p = 0.011), PLR (107.4 ± 37.3 vs. 135.8 ± 58.0; p = 0.013), and SII (445.3 ± 166.3 vs. 675.3 ± 334.0; p < 0.001) were significantly different between responder and non-responder groups. Receiver operator characteristics analysis showed the NLR (AUC 0.778; 95% CI 0.669–0.864), PLR (AUC 0.628; 95% CI 0.511–0.735), MLR (AUC 0.653; 95% CI 0.536–0.757), and SII (AUC 0.709; 95% CI 0.595–0.806) could be predictors of response to bevacizumab in patients with DME and NPDR. Patients with severe NPDR had a significantly higher ApoB/ApoA-I ratio (0.70 (0.57–0.87) vs. 0.61 (0.49–0.72), p = 0.049) and lower vitamin D (52.45 (43.10–70.60) ng/mL vs. 40.05 (25.95–55.30) ng/mL, p = 0.025). Alterations in the NLR, PLR, MLR, and SII seem to provide prognostic information regarding the response to bevacizumab in patients with DME, whilst vitamin D deficiency and the ApoB/ApoA-I ratio could contribute to better staging.

Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series.

To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.

Comparison between Focal Laser Photocoagulation and Intravitreal Bevacizumab Injection for Treating Chronic Central Serous Chorioretinopathy

Purpose: We compared the efficacy of focal laser photocoagulation and intravitreal bevacizumab injection in the treatment of chronic central serous chorioretinopathy.Methods: We conducted a retrospective analysis involving 46 eyes of 46 patients with chronic central serous chorioretinopathy who received focal laser photocoagulation (22 eyes) or intravitreal bevacizumab injection (24 eyes). Changes in best-corrected visual acuity (BVCA), central macular thickness, and rates of complete subretinal fluid (SRF) resolution and recurrence were compared over a 6-month period.Results: Although the focal laser photocoagulation and intravitreal bevacizumab injection groups demonstrated a significant reduction in central macular thickness at 6 months (<i>p</i> < 0.001), no statistically significant differences were observed between these groups at the end of the follow-up period. Notably, a gradual improvement in BVCA was observed in both groups following initial treatment, with significant improvement seen at 6 months (<i>p</i> = 0.049 and <i>p</i> = 0.048 for the laser and injection groups, respectively). However, no statistically significant difference in BVCA improvement was observed between the groups. Complete SRF resolution was achieved in 22 eyes in the laser group and 23 eyes in the injection group. Although recurrence of SRF was observed in 9 and 13 eyes in the laser and injection groups, respectively, there was no statistically significant difference between the groups (<i>p</i> = 0.229).Conclusions: Focal laser photocoagulation and intravitreal bevacizumab injection significantly improved anatomical and visual acuity outcomes in patients with chronic central serous chorioretinopathy. Although focal laser photocoagulation was associated with more rapid visual recovery and a lower recurrence rate compared to intravitreal bevacizumab injection, further studies are needed to evaluate its potential complications.

Aggressive Onset of a Progressive FEVR Phenotype in a Child With Novel Mutations in LRP5 and TSPAN12

Purpose: To describe a patient with familial exudative vitreoretinopathy (FEVR) and the treatment course. Methods: A case was evaluated. Results: A 3-year-old boy presented with severe onset of FEVR, with a subhyaloid hemorrhage in 1 eye and tractional retinal detachment (TRD) in the fellow eye. Aggressive treatment with retinal photocoagulation and repeated injections of intravitreal bevacizumab resulted in stability of the retinal disease. Lens-sparing vitrectomy was performed for the TRD. The treatment effect was durable, and the patient retained useful vision in the better eye at 19 years of age. A subsequent genetic analysis showed 2 novel heterozygous missense mutations in LRP5 and TSPAN12. Conclusions: The presence of 2 novel mutations associated with severe FEVR identified in our patient is in agreement with in vitro studies showing that a more severe reduction in Norrin/β-catenin signal activity occurs with the combination of 2 mutations.

Dose-Related Side Effects of Intravitreal Injections of Humanized Anti-Vascular Endothelial Growth Factor in Rats: Glial Cell Reactivity and Retinal Ganglion Cell Loss.

In a previous study, we documented that the Intravitreal injections (IVIs) of bevacizumab in rats caused a retinal inflammatory response. We now study whether the IVI of other humanized anti-VEGF: ranibizumab and aflibercept also cause an inflammatory reaction in the rat retina and if it depends on the dose administered. Finally, we study whether this reaction affects retinal ganglion cell (RGC) survival. Albino Sprague-Dawley rats received a single IVI of 5 µL of PBS or ranibizumab or aflibercept at the concentration used in clinical practice (10 µg/µL or 40 µg/µL) or at a lower concentration (0.38 µg/µL and 1.5 µg/µL) calculated to obtain within the rat eye the same concentration as in the human eye in clinical practice. Others received a single 5 µL IVI of a polyclonal goat anti-rat VEGF (0.015 µg/µL) or of vehicle (PBS). Animals were processed 7days or 1month later. Retinal whole mounts were immunolabeled for the detection of microglial, macroglial, RGCs, and intrinsically photosensitive RGCs (ipRGCs). Fluorescence and confocal microscopy were used to examine retinal changes, and RGCs and ipRGCs were quantified automatically or semiautomatically, respectively. All the injected substances including the PBS induced detectable side effects, namely, retinal microglial cell activation and retinal astrocyte hypertrophy. However, there was a greater microglial and macroglial response when the higher concentrations of ranibizumab and aflibercept were injected than when PBS, the antibody anti-rat VEGF and the lower concentrations of ranibizumab or aflibercept were injected. The higher concentration of ranibizumab and aflibercept resulted also in significant RGC death, but did not cause appreciable ipRGC death. The IVI of all the substances had some retinal inflammatory effects. The IVI of humanized anti-VEGF to rats at high doses cause important side effects: severe inflammation and RGC death, but not ipRGC death.

A combination of suprachoroidal injection of triamcinolone using a custom-made needle and intravitreal Ziv-aflibercept every eight weeks to manage naïve/denovo central DME: a single-center retrospective case series

BackgroundPrevious studies have shown promising effects of combining intravitreal bevacizumab and suprachoroidal injection of triamcinolone acetonide in treating DME. However, further research is needed.ObjectiveTo assess the efficacy and safety of combining both intravitreal Ziv-aflibercept and suprachoroidal injection of triamcinolone acetonide using a custom-made needle in naïve and de novo central diabetic macular edema (DME) patients every eight weeks for 24 weeks.MethodsCentral macular thickness was measured via spectral domain-optical coherence tomography, and best-corrected visual acuity was measured via a Snellen chart at baseline and at 4, 8, 12, 16, and 24 weeks postinjection. Additionally, cataract progression, intraocular pressure (IOP), and ocular safety were analyzed.ResultsA total of 10 eyes of 6 patients were treated with suprachoroidal injections of triamcinolone acteonid combined with an intravitreal injection of Ziv-aflibercept. Vision improved from 0.69 log minimum angle of resolution (MAR) at baseline to 0.39 log MAR after treatment. Central macular thickness significantly decreased from 462.3 ± 166 μm at baseline to 362.7 ± 77.6 μm at 24 weeks postinjection.ConclusionSuprachoroidal injection of triamcinolone using a custom-made needle with the intravitreal agent Ziv-aflibercept to treat de novo/naïve central DME has favorable outcomes and adequate safety results. Moreover, this study demonstrated the benefit of adapting the previous treatment combination for extending the interval between anti-VEGF treatments from 4 to 8 weeks, which could prevent further expenses, especially in low-income countries.However, large multicenter randomized clinical trials with longer follow-up periods are needed to assess this treatment route, especially in low-income and resourced countries.

Association Of Conjunctival Vitreous Reflux With Intraocular Pressure Spikes After Intravitreal Bevacizumab Injection

Objective: To evaluate the effect of conjunctival vitreous reflux on intraocular pressure immediately after intravitreal bevacizumab injection. Methods: A prospective interventional study was done at Benazir Bhutto Hospital, for 6 months from 13-01-2021 to 12-07-2021.Patients were selected through a non-probability consecutive sampling technique. A total of 88 eyes undergoing intravitreal bevacizumab were included in the study. IOP was checked before injection, immediately after injection, at 30 minutes and 60 minutes. The presence or absence of conjunctival reflux was noted. Data was analyzed to see the association of post-injection IOP and conjunctival reflux. Results: Those having conjunctival reflux positive had mean Intraocular pressure before intravitreal injection 13.14+2.569, the p-value was 0.0001. Immediately after injection at 0 minutes it was 27.95+3.988, and the p value was 0.0001. At 30 minutes, it was reduced to 21.58+2.814, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 17.26+1.853, and the p-value was 0.001. Those having conjunctival reflux negative had mean Intraocular pressure before intravitreal injection 13.44+2.981, p-value 0.0001. Immediately after injection at 0 minutes it was 33.69+5.608, and the p-value was 0.0001. At 30 minutes, it was reduced to 24.51+5.337, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 18.98+2.973, and the p-value was 0.001. Conclusion: Patients with vitreous reflux positive had less IOP elevation as compared to those with vitreous reflux negative. Keywords: Intravitreal bevacizumab injection, Intraocular pressure, conjunctival reflux.

Choroidal Osteoma with Choroidal Neo Vascular Membrane

Choroidal osteoma (CO) is a rare benign tumor usually unilateral and have a female preponderance. We report a case of a 34-year-old healthy malediagnosed with unilateral Choroidal Osteoma with an associated Choroidal NeoVascularMembrane(CNVM).Thediagnosiswasconfirmedbasedonclinicalexamination, typical findings on B-scan, Fundus fluorescein angiography,Indocyanine green angiography and Optical coherence tomography. The CNVMwas treated with intravitreal Bevacizumab injections and showed a good responseinitially.TherewasarecurrenceofCNVMovertwoyearswhenpatientwaslosttofollow-up. Treatmentwith intravitreal Ranibizumab bio similar injection helpedstabilize hisvision. Regular follow-up is essential for timely treatment ofrecurrenceof CNVMand optimum visualoutcomes.

Bilateral recurrent choroidal neovascularization in AZOOR

A 61-year-old man presented with recurrent bilateral peripapillary choroidal neovascularization (CNV), which was treated with intravitreal bevacizumab injections. Fundus autofluorescence revealed the typical acute zonal occult outer retinopathy (AZOOR) trizonal pattern, so the patient was started on immunosuppressive treatment with prednisone and methotrexate, and subsequently with mycophenolate mofetil due to recurrent inflammatory activity. While on immunosuppressive treatment, further CNV showing the “pitchfork sign” appeared in the right eye and required multiple bevacizumab injections due to persistent activity. The complication of CNV in AZOOR is very rare and treatment is a challenge. However, the combination of intravitreal anti-VEGF with immunosuppressive treatment could prevent the progression of the disease.

A Case Report on IRVAN Syndrome

Idiopathic retinal vasculitis, arteriolar macroaneurysms, and neuroretinitis (IRVAN) is a rare condition predominantly affecting young, healthy females without systemic disease. We present the case of a 35-year-old female who presented with a 3-month history of decreased visual acuity without associated symptoms. Ophthalmological examination revealed reduced visual acuity in both eyes, papillary oedema, stellate macular oedema, and haemorrhages bilaterally. Retinal imaging confirmed IRVAN syndrome. Treatment included pan-retinal photocoagulation (PRP) and intravitreal bevacizumab injections, resulting in macular oedema regression.

Evaluation of Photodynamic Therapy-combined Intravitreal Bevacizumab in Age-related Macular Degeneration

Aim: It was aimed to compare treatment results of photodynamic therapy (PDT) and PDT-combined intravitreal bevacizumab injection (PDT+IVB) in patients with age-related macular degeneration (AMD). Material and Methods: 63 eyes of 55 patients with neovascular AMD were included. Group 1 consisted of 40 eyes of 35, group 2 consisted of 23 eyes of 20 patients. Visual acuity (VA), intraocular pressure measurement and fundus examination were performed. Pattern Electroretinography P50 amplitude and edema map values (EMV) were measured with Heidelberg Retina Tomograph (HRTII). Results: VA increased in 14, remained unchanged in 17, decreased in 9 eyes in Group 1 (PDT). The PERG P50 amplitudes were compared with values of pre-treatment, and found increased as 10.6%, 11.98%, and 8.46% and HRTII EMV were 5.86%, 4.88%, and 11.22% at 1st, 3rd, and 6th months, respectively. In Group 2 (PDT+IVB), VA improved in 9, remained unchanged in 8, decreased in 6 eyes. PERG P50 amplitudes were decreased as 10.15%, 5.8%, and 0.1% and HRTII EMV were decreased as 13.07%, 12.17%, and 14.87% at 1st, 3rd, and 6th months, respectively. Conclusion: Verteporfin and PDT are effective and safe methods that preserve VA in subfoveal choroidal neovascular membranes due to neovascular AMD.

Short-Term Effects of Adding Topical Ketorolac to Intravitreal Bevacizumab in Diabetic Macular Edema: A Crossover Randomized Clinical Trial.

To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME). In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT). Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was -0.09 0.47 logMAR in the periods of receiving ketorolac and -0.03 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were -13.1 170.1 and +11.7 157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012). This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period.

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.

Topical Dorzolamide as Adjunctive Treatment With Intravitreal Bevacizumab in Bilateral Diabetic Macular Edema.

Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is accepted as the gold standard treatment for center-involving diabetic macular edema (CI-DME). Adjunctive administration of topical dorzolamide may enhance the therapeutic effects of anti-VEGF agents. In this study, we compared the efficacy of topical dorzolamide plus intravitreal injection of bevacizumab (IVB) versus IVB alone in patients with bilateral DME. This prospective, randomized contralateral eye study was carried out in a tertiary referral ophthalmology center, Al-Zahra Eye Hospital, Zahedan, Iran, between April 2021 and April 2022. Thisstudy included 50 eyes of 25 patients with bilateral DME. All eyes received three consecutive monthly injections of IVB. For each patient, one eye was randomized to instill dorzolamide eye drops three times a day as an intervention, and the other received artificial tear drops as a placebo. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were evaluated before starting treatment and then monthly for the first three months. Among 25 included patients, the average age was 56.64 ± 7.97 years, and 48% were female. BCVA did not improve significantly in any groups (P > 0.05). No significant difference was observed in terms of BCVA between the intervention and control groups (P > 0.05). The present study showed a decrease in CMT in both study groups (P < 0.05). At month 3, the decrease in mean CMT from baseline was significantly higher in eyes receiving topical dorzolamide compared to the control group (-88.92 ± 82.90 vs. -37.64 ± 86.16 µM, respectively; P = 0.037). IOP decreased significantly only in eyes receiving dorzolamide (P < 0.001). The results of the present study indicate that adjunctive administration of topical dorzolamide has a beneficial effect on CMT reduction from baseline, but it did not have an additive effect on BCVA improvement compared to IVB monotherapy.

An Adolescent Case of Unilateral Papillophlebitis Treated with Intravitreal Bevacizumab

Purpose: To report a case of papillophlebitis treated with an intravitreal bevacizumab injection in an adolescent patient.Case summary: A 15-year-old female with no medical history presented with a 3-day history of blurred vision and a floating sensation. The initial visual acuity (VA) was 0.0 logarithm of minimal angle of resolution (logMAR) in the left eye. A fundus examination revealed a blurry disc margin, peripapillary hemorrhage, and venous engorgement. Optical coherence tomography indicated subretinal fluid (SRF) accumulation. Both color vision and pupillary reactions were normal in bilateral eyes. Blood tests revealed no significant abnormalities. Brain magnetic resonance imaging (MRI) showed mild focal papillitis, but the patient did not report eye movement pain or discomfort. The diagnosis was papillophlebitis; however, high-dose steroid treatment was not initiated due to the absence of a significant decrease in VA. A single injection of intravitreal bevacizumab was administered to address the SRF. At the 9-month follow-up, VA remained at 0.0 logMAR, and the retina demonstrated anatomical stabilization after complete absorption of the SRF without recurrence.Conclusions: Papillophlebitis can manifest during adolescence. Treatment of a 15-year-old patient with intravitreal bevacizumab obviated the need for high-dose steroid therapy and produced favorable outcomes, including preservation of VA and anatomical stabilization of the retina.

Bevacizumab vs Ranibizumab in Macular Edema due to Retinal Vein Occlusion: Short-term Outcomes

Introduction &amp; ObjectivesBevacizumab or Ranibizumab was widely used as therapy for macular edema (ME) in retinal veinocclusion (RVO) and diabetic retinopathy. The purpose of this study was to comparing short-termoutcomes for patients who received intravitreal Bevacizumab (IVB) injection or Ranibizumab (IVR)for ME due to RVO&#x0D; MethodsThis was observational, cross sectional study comparing patients received IVB or IVR. Primaryoutcomes data (visual acuity and central macular thickness/CMT) and secondary outcomes data(number injection and intra ocular pressure/IOP) were collected at baseline and 3 months afterinjection&#x0D; ResultsThere were 4 eyes in each group. There were no significant difference in mean change of visualacuity (-0.275±0.25 vs -0.15±0.5 logMAR; p=0.676) and CMT (-171.50±129.08 vs -98.25±37.67 um;p=0.345) in IVB vs IVR groups. There were also no significant difference in mean change of IOP(2±2.16 vs 2±4.69 mmHg; p=1) and number of injection (2.25±0.50 vs 1.75±0.9; p=0.401 ) in bothgroups.&#x0D; ConclusionIn short-term both IVB and IVB have relative similar outcomes on increasing visual acuity anddecreasing CMT in ME due to RVO

Comparation of Bevacizumab Intravitreal Injection Effects with and without Yellow Subthreshold Micropulse Laser (577-nm) Combination on Central Macular Thickness and Best Corrected Visual Acuity of Mild-Moderate Diabetic Macular Edema Patients

Introduction &amp; ObjectivesThe management of macular edema is constantly evaluated, with anti-VEGF therapy being the firstline. Subthreshold micropulse laser (SML) has been proposed as alternative adjuvant. Previousretrospective studies demonstrated the effectiveness of 577-nm SML as monotherapy in macularedema with CMT below 400 ?m. However, prospective data on the effectiveness of SML as adjuvantis lacking. The aim is to assess the effect of the combination of bevacizumab and 577-nm SML lasercompared to bevacizumab monotherapy on central macular thickness and visual acuity in mildmoderatediabetic macular edema patients.&#x0D; MethodsA prospective randomized clinical trial was performed on diabetic macular edema patients withmacular thickness range of 300-600 ?m. Subjects are divided into two groups. The control groupreceived a standard protocol and the study group received a yellow SML laser adjuvant one weekafter injection. Patients underwent follow-up assessment of visual acuity and central macularthickness at 28 and 35 days post-injection.&#x0D; Results26 subjects were equally divided into study and control groups. Significant decrease in CMT werefound in study group (p=0.011 and 0.014) and the control group (p=0.006 and p=0.001). However,there was no significant difference in ?CMT values between the two groups in the 28-day (p=0.317)and 35-day controls (p=0.84). There was no difference in ?BCVA ETDRS between the study andcontrol groups at 28 days (p=0.568) and 35 days (p=0.128) after injection.&#x0D; ConclusionThe combination of SML and intravitreal bevacizumab can reduce central macular thickness andimprove visual acuity but there was no significant difference with standard monotherapy.

LONGITUDINAL CHANGES IN CHOROIDAL THICKNESS IN CHILDREN WITH A HISTORY OF PREMATURITY: An 18-Month Prospective Cohort Study.

To evaluate choroidal changes over time in school-age children with a history of prematurity. A study of 416 eyes of 208 eligible participants, including 88, 190, 36, 56, and 46 eyes in the full-term control, preterm, spontaneously regressed retinopathy of prematurity, intravitreal bevacizumab (injection of bevacizumab)-treated retinopathy of prematurity, and laser-treated retinopathy of prematurity groups, respectively, were enrolled in this study. The choroidal thickness was measured 4 times at 6-month intervals using optical coherence tomography. Of all the groups, the laser-treated children had the thinnest choroid compared with full-term children (-52.3 µ m, P = 0.04). Preterm children exhibited greater attenuation in choroidal thickness over time than did full-term children (-6.3 ± 26.9 and -1.1 ± 12.8 µ m/year, P = 0.03), whereas no difference was observed between injection of bevacizumab and laser treatments (-4.6 ± 18.9 and -2.0 ± 15.7 µ m/year, P = 0.46). In all groups, the changes in axial length were negatively associated with the changes in choroidal thickness (all P < 0.05). A greater attenuation in choroid thickness over time was observed in preterm children than in full-term children, but this attenuation did not differ between injection of bevacizumab and laser treatments. Axial elongation was associated with choroidal thinning in school-age children.

Trends in Anti-Vascular Endothelial Growth Factor Original Medicare Part B Claims in the United States, 2014–2019

ABSTRACT Purpose To characterize trends in use of and expenditure for the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents aflibercept, ranibizumab, and bevacizumab among the population enrolled in Original Medicare from 2014 to 2019. Methods The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to extract Medicare Part B fee-for-service outpatient injection claims data submitted by ophthalmologists. Multivariable linear regression models were used to evaluate the association between reimbursement, ophthalmologist availability, and agent administration rate. Results Between 2014 and 2019, 17,588,995 intravitreal injection claims were filed by 4218 US ophthalmologists. Medicare costs for anti-VEGF injections increased from 2.51 B USD in 2014 to 4.02 B USD in 2019. Increased state-level ophthalmologist availability and incremental increases in average reimbursement amounts were found to be significantly associated with a 6.8-fold variation in 2019 overall anti-VEGF injection rates across states. Conclusions Medicare injection rates and costs for anti-VEGF injections have both increased between 2014 and 2019, largely driven by increased aflibercept use. There is a significant association between ophthalmologist availability and anti-VEGF injection rate on the state level, suggesting access to care may contribute to the observed state-level disparities in intravitreal injection rates. Further characterization of factors contributing to the state-level variation in injection rates of individual anti-VEGF agents may help inform interventions promoting equitable access to and use of these drugs.