Intravitreal Bevacizumab Treatment Research Articles

Occult retinal neovascularization following intravitreal bevacizumab and laser treatment for retinopathy of prematurity

BackgroundWe present a patient with retinopathy of prematurity (ROP) who developed worsening plus disease after complete regression of stage 3 ROP. The use of fundus fluorescein angiography (FFA) aided the visualization of occult neovascularization that caused the disease progression.Case presentationThe patient was at high risk for ROP due to low birth weight of 690 g and gestational age of 25 weeks. After the diagnosis of stage 3 ROP in zone I without plus disease, she was treated initially with bilateral intravitreal bevacizumab (IVB) and followed by laser photocoagulation 5 weeks later. Despite the resolution of ROP stage, the plus disease worsened. Neither systemic risk factors nor skip laser areas were observed. Hence, FFA was performed and subsequently identified occult neovascularization with active leakage. Additional IVB and laser treatment in the capillary dropout area inside vascularized retina were added. The plus disease improved but mild arteriolar tortuosity persisted.ConclusionsWorsening of plus disease after completion of laser ablation and IVB with complete regression of stage 3 ROP is rare. Systemic risk factors such as continuous oxygen therapy and cardiovascular disease should be ruled out. FFA aided in identifying occult neovascularization and prompted further treatment.

Two Cases of Massive Subretinal Fluid Accumulation after Photodynamic Therapy for Age-related Macular Degeneration

Purpose: To report two cases of massive subretinal fluid accumulation at laser irradiated sites after photodynamic therapy in patients with age-related macular degeneration (ARMD).Case summary: (Case 1) A patient with bilateral polypoidal choroidal vasculopathy, who was treated with half-dose verteporfin photodynamic therapy (PDT), developed decreased visual acuity. On fundus examination, massive subretinal fluid accumulation was observed in the laser irradiated sites of both eyes. The subretinal fluid was reabsorbed without further treatment, and the patient's visual acuity has recovered. (Case 2) A patient with ARMD, accompanied by a choroidal neovascular membrane and accumulation of subretinal fluid in the right eye, developed decreased visual acuity on the treated eye a day after receiving half-dose PDT treatment. On fundus examination, the subretinal fluid in the right eye had increased more than 5-fold compared to pre-treatment levels. After one week, the amount of subretinal fluid decreased and the patient's visual acuity improved. However, since retinal exudate still remained, intravitreal bevacizumab treatment was administered. Thereafter, the patient’s fundus findings were unremarkable.Conclusions: In the case of photodynamic therapy for ARMD, a large amount of subretinal fluid may occur as a rare complication. The subretinal fluid was naturally absorbed, but close observation is needed with the possibility of developing subretinal fluid in the event of decreased vision after photodynamic therapy.

Comparison of the Efficiency and Safety of Photodynamic Therapy Combined Intravitreal Bevacizumab and Intravitreal Triamcinolone Treatments in Age-Related Macular Degeneration

Objective: This study aims to retrospectively examine the mid and long-term results of the photodynamic therapy (PDT) +IVTA group and the PDT +IVB applied Group in the treatment of choroid neovascularization (CNV) due to age-related macular degeneration (AMD) and to compare the results with the results of multicenter clinical studies. Materials and Methods: 64 eyes of 64 patients admitted to Haseki Training and Research Hospital, Department of Ophthalmology, Retina unit between June 2003 and March 2009, diagnosed with CNV secondary to age-related macular degeneration and treated, were included in the study. Thirty-five eyes with PDT +IVTA were classified as Group I, and 29 with PDT +IVTA were classified as Group II. Visual acuities of the cases were evaluated with ETDR and Snellen charts and converted to their equivalents on the Logarithm of Minimal Angle of Resolution (logMAR) scale. All patients underwent an ophthalmological examination before and after the treatment; fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to see if there was any recurrence in the patients. Patients who were found to have relapsed were re-treated. Results: There were 26 (40.6%) female cases and 38 (59.4%) male cases. The ages ranged from 55 to 88, with a mean age of 73.85±7.26. The follow-up period of the patients ranged from 5 months to 69 months; the mean was 17.65±13.48 months. When evaluated according to FFA images, 40 (62.5%) were occult, 12 (18.8%) were minimal-classical, and 12 (18.8%) were dominant-classical. After treatment, visual acuity decreased in 20% of the PDT +IVTA group and increased or remained the same in 80%. In the PDT +IVB group, blurred vision decreased by 27.6% and increased or remained the same by 72.4%. There was no statistically significant difference between the groups regarding the change in visual acuity after treatment compared to before treatment (p>0.05). In OCT, the decrease in the mean central foveal thickness (CFT) after treatment compared to the mean CFT before treatment in Group I was statistically significant (p<0.05). In Group II - the decrease in the mean CFT after treatment compared to the mean CFT before treatment was statistically significant (p<0.01). In Group I, there was no statistically significant change in the mean lesion diameter after treatment compared to the mean lesion diameter before treatment (p>0.05). However, the decrease in Group II was statistically significant (p<0.01). While the increase in CFT (central foveal thickness) and lesion diameter was more pronounced in the PDT+IVTA group post-treatment compared to the pre-treatment group, no significant difference was observed in visual acuity change within the PDT+IVTA group. Conclusion: In the treatment of choroidal neovascularization secondary to age-related macular degeneration, the combination of Triamcinolone or Bevacizumab with photodynamic therapy has proven to be both effective and safe. This approach helps preserve the current vision and even enhance visual outcomes. Combination therapy reduces the frequency and number of monotherapies used to achieve visual success.

Long-term outcomes of visual motor integration and motor development children with retinopathy of prematurity.

Premature infants have a risk of neurodevelopmental deficits. Little is known, however, about how retinopathy of prematurity (ROP) affects visual motor integration (VMI), which is necessary for both fine motor skills and further school abilities. Due to the systemic escape of bevacizumab in the treatment of ROP, concerns regarding the long-term neurodevelopmental effect of the drug have arisen. The aim is to evaluate VMI and motor development long-term outcomes after intravitreal bevacizumab (IVB) injection and laser treatment for ROP. Two groups of premature children were included: Bevacizumab group - 16 premature children who received IVB treatment and laser group - 23 premature children who underwent laser photocoagulation treatment in this single center cross-sectional study. At 2-6 years of age, VMI (Beery-Buktenica Developmental Test), motor development (Peabody Developmental Motor Scales-2), visual acuity, and refractive status were assessed. The incidence of abnormal visual function was significantly higher in bevacizumab group than in laser group (p = 0.022). The incidence of abnormal VMI skill was significantly higher in bevacizumab group than in laser group (p = 0.024). Incidences of abnormal gross, fine, and total motor skills were significantly higher in bevacizumab group compared to laser group (p < 0.05). Premature children who received bevacizumab for ROP demonstrated significantly lower VMI and motor development features than those with laser treatment at preschool age. Although our results suggest the relevance of bevacizumab injection in impaired VMI and motor development outcomes, general level of sickness rather than treatment might be the cause of delayed motor development.

Response of Pigment Epithelial Detachment to Three-Loading-Dose of Intravitreal Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration

Objective: Response of pigment epithelial detachment (PED) to three loading dose of intravitreal bevacizumab (IVB) treatment in neovascular age-related macular degeneration (nAMD) cases.&#x0D; Methods: OCT findings (PED height (µm), diameter(µm) and area (mm²), central macular thickness (CMT), central choroidal thickness (CCT), intraretinal fluid (IRF), subretinal fluid (SRF)), and morphological features of macular neovascularization (MNV) in OCTA before and after three loading doses of IVB were examined and compared.&#x0D; Results: Forty-two eyes of 42 naive nAMD patients with PED were included. Fifteen patients had serous and 27 patients had fibrovascular PED. After three loading doses, best corrected visual acuity (BCVA) (in Snellen) increased from 0.22±0.19 to 0.29±0.22 (p

Retinopathy of Prematurity and Intravitreal Bevacizumab Treatment: Single Center Experience

Bu çalışmanın amacı üçüncü basamak bir devlet hastanesinde doğan prematüre bebeklerdeki prematüre retinopatisi (ROP) sıklığı, ROP saptanan ve tedavi gereken bebeklerin özellikleri, uygulanan tedavi ve takip süreçleri ile ilgili deneyimlerin paylaşılmasıdır. Çalışmada 35 haftadan erken doğan prematüre bebeklerin verileri retrospektif olarak incelendi. ROP gelişen bebekler içinde tedavi endikasyonu konan ve konmayan bebeklerin verileri karşılaştırıldı. Çalışmada iki yıllık süre içerisinde ünitemizde tedavi görmüş ve ROP açısından takipleri tamamlanmış olan, 112 bebeğin verileri değerlendirildi. Bebeklerin ortalama gestasyonel yaşı 28,37±2,55 hafta, ortalama doğum ağırlığı 1171,66±405,17 gram idi. Bebeklerin 44 tanesinde (%39,2) ROP saptandı. ROP gelişen bebekler arasında tedavi endikasyonu alanlar (n: 10) daha düşük doğum ağırlığı ve daha yüksek oranda inotrop gereksinimi olan bebeklerdi (p

Towards a population pharmacokinetic/pharmacodynamic model of anti-VEGF therapy in patients with age-related macular degeneration

PurposeTo develop a population pharmacokinetic/pharmacodynamic model (popPKPD) of intravitreal bevacizumab treatment for neovascular age-related macular degeneration (nAMD) patients to learn about the PK/PD relationship and utilise it for dosing regimen decisions on future nAMD patients. MethodsThe Greater Manchester Avastin for Neovascularisation (GMAN) randomised clinical trial data was retrospectively utilised, and the best-corrected visual acuity (BCVA) and central macular retinal thickness (CRT, measured by optical coherence tomography) were the PD inputs to the model. Using the nonlinear mixed-effects method, the best PKPD structural model was investigated, and the clinical significance of the two different dosing treatment regimens (as-needed versus routine) was evaluated. ResultsA structural model to describe the change of BCVA from the baseline of nAMD patients was successfully obtained based on the turnover PD model concept (drug stimulates the “visual acuity response production”). The popPKPD model and simulation indicate that the routine regimen protocol improves patient visual outcome compared to the as–needed protocol.For the change in CRT, the turnover structural PKPD model was too demanding to fit to the given clinical data. ConclusionsThis is the first popPKPD attempt in nAMD treatment that shows the potential of this strategy to understand/inform the dosing regimen. Clinical trials with richer PD data will provide the means to build more robust models.

A Comparison between Intravitreal Bevacizumab Injection and Placement of a Dexamethasone Implant to Treat Retinal Vein Occlusion Macular Edema

Purpose: We evaluated the macular, functional and structural features of patients with retinal vein occlusion and macular edema. We measured the best-corrected visual acuity (BCVA), central foveal thickness, and the area of the foveal avascular zone area after intravitreal bevacizumab (IVB) treatment and placement of a dexamethasone implant (IVD).Methods: We retrospectively reviewed 36 eyes of 36 patients with retinal vein occlusion and macular edema who underwent IVB treatment (20 eyes) and IVD placement (16 eyes). The parameters mentioned above were compared between the two treatment groups and the normal contralateral eyes after initial stabilization and 1 year later.Results: The BCVA was significantly higher in the IVB than the IVD group after initial stabilization and 1 year later. The intraocular pressure was lower at initial stabilization in the IVB than the IVD group, but no difference was apparent after 1 year. There was no significant between-group difference in the central foveal thickness at any time, but the IVD group required fewer injections during initial stabilization than the IVB group. In terms of the foveal avascular zone area, both the superficial and deep layers of the IVB group increased significantly during the initial stabilization period and then decreased to 1 year; no changes were seen in the IVD group.Conclusions: IVD treatment is associated with fewer injections than IVB treatment and a more stable retinal vasculature, but visual acuity may possibly decrease (because of cataract formation). Although IVB treatment improves visual acuity and reduces macular edema, this may be associated with an increased risk of macular ischemia given the need for repeated injections.

Reactivation of retinopathy of prematurity after intravitreal bevacizumab monotherapy in aggressive posterior retinopathy of prematurity

Aims: The aim of the study was to identify the risk factors and timing for the reactivation of retinopathy of prematurity (ROP) after intravitreal bevacizumab (IVB) in aggressive posterior retinopathy of prematurity (APROP). Materials and Methods: A retrospective study to analyze the outcome of 24 eyes of 12 infants treated with IVB monotherapy (0.625 mg) was done. Data were analyzed regarding the initial response to IVB, the incidence of ROP reactivation, timing, location, and stage of reactivation. Gestational age, postmenstrual age, and other neonatal comorbid risk factors were compared between the reactivation and those without reactivation after IVB. Results: The mean follow-up time was 50.2 ± 1.4 weeks after IVB. Reactivation was identified in 8 (33.3%) eyes. Reactivation in zone I was seen in only two eyes and zone II reactivation was present in six eyes. The mean postmenstrual age at the time of recurrence was 44.0 ± 1.15 weeks (range: 43–45). The mean time between initial treatment and treatment-requiring recurrence was 11.8 ± 0.9 weeks. Multiple pregnancy, low birth weight, sepsis, and necrotizing enterocolitis were significantly associated with ROP reactivation. None of our patients progressed to retinal detachment after laser treatment for reactivation. Conclusions: Although IVB treatment is effective in inducing the regression of APROP, the effect may be transient. The recurrence of ROP should be carefully watched in a long-term follow-up after IVB monotherapy, particularly in the first 12 weeks after IVB.

Comparison Between Intra Vitreal Bevacizumab and Triamcinolone in Reducing Macular Thickness in Central Retinal Vein Occlusion

Objectives: To compare the effect of intra vitreal bevacizumab (IVB) and intra vitreal triamcinolone (IVT) in reducing macular thickness in central retinal vein occlusion. Methods and Materials: This quasi experimental study was conducted at Department of Ophthalmology, Hayat Abad Medical Complex Peshawar in the period from 01 January 2020 to 30 June 2020. Total 40 patients presented with central retinal vein occlusion (CRVO). Patients were divided into two groups, group A received IVB treatment and group B received IVT treatment. The patients were followed up on 6th month post treatment. The primary outcomes of the study were visual acuity and reduction in macular thickness on OCT post treatment. Results: 40 patients were enrolled in the study. The mean age of patients was 60.70±15.49 in group A and in group B 60.40±12.83. There were 13 males and 7 females in group A and 12 males and 8 females in group B. Mean VA at baseline was 1.0825±0.25 logMAR in group A and 0.9745±0.29 logMAR in group B. Mean macular thickness at baseline was 625.40±47.15 µm in group A and 642.05±44.23 µm in group B. Mean VA at 6th month post treatment follow up was 0.4195±0.23 logMAR in group A and in group B was 0.4960±0.27 logMAR. At 6th month follow up macular thickness was 261.80±26.269 µm in group A and 263.80±22.209 µm in group B. Conclusion: Intravitreal injections of bevacizumab and triamcinolone have shown a reduction in macular edema in CRVO patients along with improvement in visual acuity. Keywords: Bevacizumab, Triamcinolone, Macular Edema, Central Retinal Vein Occlusion, Visual Acuity

Pulmonary function in school-age children following intravitreal injection of bevacizumab for retinopathy of prematurity

The effect of anti-vascular endothelial growth factor on neonatal lung development was inconclusive. To evaluate pulmonary function in school-age children who have received intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP), this study included 118 school-aged children who were grouped into three groups: full-term control children (group 1), preterm children who had not received IVB treatment (group 2) and preterm children with ROP who had received IVB treatment (group 3). Pulmonary function was measured by spirometry and impulse oscillometry. Pulmonary function was significantly better in group 1 than in groups 2 and 3 (all p < 0.05 in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25 and 75% of FVC (FEF25–75), and respiratory resistance at 5 Hz and difference between respiratory resistance at 5 and 20 Hz (R5-R20). There were no statistically significant differences between group 2 and group 3 in all pulmonary function parameters, including FVC, FEV1, ratio of FEV1 to FVC, FEF25-75, R5, R20, R5–R20, and respiratory reactance at 5 Hz. In conclusion, our study revealed that preterm infants receiving IVB for ROP had comparable pulmonary function at school age to their preterm peers who had not received IVB treatment.

Outcomes of Second-Line Intravitreal Anti-VEGF Switch Therapy in Radiation Retinopathy Secondary to Uveal Melanoma: Moving from Bevacizumab to Aflibercept

Introduction: Radiation retinopathy is a dose-dependent complication of the retina following exposure to ionizing radiation. The objective of this prospective case series is to determine the clinical efficacy of intravitreal aflibercept for radiation retinopathy secondary to radiotherapy for uveal melanoma in those that failed intravitreal bevacizumab treatment. Methods: A case series of 30 patients with a mean age of 57 ± 15 years with radiation retinopathy were enrolled. Visual acuity (VA) and central foveal thickness (CFT) responses to therapy were assessed with regression analyses at 1 month, 3 months, and 6 months following the switch to aflibercept. Results: Regression analyses showed a statistically significant reduction in CFT and improvements in VA following the switch to treatment by aflibercept at 1 month, 3 months, and 6 months. The mean CFT improved from 476 μm ± 170 to 386 μm ± 139 and the mean VA improved minimally from 20/115 ± 20/63 to 20/112 ± 20/54 over 6 months. After 6 months of aflibercept, 46% of patients displayed a CFT improvement of 100 μm or greater and 23% of patients showed improvement in VA of 1 line or better. Conclusion: This pilot study suggests that patients with radiation retinopathy who have failed monthly intravitreal bevacizumab may respond to aflibercept.

Age differential response to bevacizumab therapy in choroidal neovascularization in rabbits

Choroidal neovascularization (CNV) in young rabbits has been shown to have a rapid, robust response after treatment with bevacizumab, an anti-vascular endothelial growth factor (VEGF) medication. This investigation evaluates an age differential response to bevacizumab in older populations of rabbits using multimodal high resolution molecular imaging. Young (4 months old) and life span (14 months old) rabbits were given subretinal injections of Matrigel and VEGF to produce CNV. All CNV rabbit models were then treated with a bevacizumab intravitreal injection. Rabbits were then monitored longitudinally using photoacoustic microscopy (PAM), optical coherence tomography (OCT), color photography, and fluorescence imaging. Chain-like gold nanoparticle clusters (CGNP) conjugated with tripeptide arginylglycylaspartic acid (RGD) was injected intravenously for molecular imaging. Robust CNV developed in both young and old rabbits. After intravitreal bevacizumab injection, fluorescence signals were markedly decreased 90.13% in the young group. In contrast, old rabbit CNV area decreased by only 10.56% post-bevacizumab treatment. OCT images confirmed a rapid decrease of CNV in the young group. CGNPs demonstrated high PAM signal in old rabbits and minimal PAM signal in young rabbits after bevacizumab, indicating CNV regression. There is a significant difference in response to intravitreal bevacizumab treatment between young and old rabbits with CNV which can be monitored with multimodal molecular imaging. Old rabbits demonstrate significant persistent disease activity. This represents the first large eye model of persistent disease activity of CNV and could serve as the foundation for future investigations into the mechanism of persistent disease activity and the development of novel therapies.

Intravitreal Bevacizumab Is Associated With Prolonged Ventilatory Support in Preterm Infants With Bronchopulmonary Dysplasia

Intravitreal bevacizumab (IVB), an anti-vascular endothelial growth factor (VEGF) antibody, is a widely adopted treatment for retinopathy of prematurity (ROP). Although animal studies have demonstrated that IVB inhibits alveologenesis in neonatal rat lung, the clinical influence of IVB on respiratory outcomes has not been studied. Does IVB affect the respiratory outcome in preterm infants with bronchopulmonary dysplasia? We retrospectively assessed very low birth weight (VLBW) preterm infants admitted to our neonatal ICU between January 2016 and June 2021. Furthermore, we evaluated the short-term respiratory outcomes after IVB therapy in VLBW preterm infants requiring ventilatory support at 36weeks' postmenstrual age (PMA). One hundred seventy-four VLBW preterm infants with bronchopulmonary dysplasia were recruited. Eighty-eight infants showed ROP onset before being ventilator free, and 78 infants received a diagnosis of the most severe ROP before being ventilator free. Among them, 32 received a diagnosis with type 1 ROP and received IVB treatment. After adjusting for gestational age, birth body weight, and baseline respiratory status, we discovered that IVB is associated significantly with prolonged ventilatory support and a lower likelihood of becoming ventilator free (hazard ratio, 0.53; P= .03). IVB may have a short-term respiratory adverse effect in patients requiring ventilatory support at 36weeks' PMA. Therefore, long-term follow-up for respiratory outcomes may be considered in VLBW infants who receive IVB treatment.

Retinopathy of Prematurity Treatment Trends from 2003 to 2020 in the United States

Retinopathy of prematurity (ROP) is a leading cause of blindness in children in the United States, despite treatment. 1 Ludwig C.A. Chen T.A. Hernandez-Boussard T. et al. The epidemiology of retinopathy of prematurity in the United States. Ophthalmic Surg Lasers Imaging Retina. 2017; 48: 553-562 Crossref PubMed Scopus (70) Google Scholar , 2 Prakalapakorn S.G. Greenberg L. Edwards E.M. Ehret D.E.Y. Trends in retinopathy of prematurity screening and treatment: 2008-2018. Pediatrics. 2021; 147: 1-8 Crossref Scopus (8) Google Scholar , 3 Zhang M.H. Blair M.P. Ham S.A. Rodriguez S.H. Two-year outcomes comparing anti-VEGF injections to laser for ROP using a commercial claims database. Ophthalmic Surg Lasers Imaging Retina. 2020; 51: 486-493 Crossref PubMed Scopus (3) Google Scholar Laser and anti-vascular endothelial growth factor (VEGF) injections are the primary treatment for ROP. 4 Lepore D. Quinn G.E. Molle F. et al. Intravitreal bevacizumab versus laser treatment in type 1 retinopathy of prematurity: report on fluorescein angiographic findings. Ophthalmology. 2014; 121: 2212-2219 Abstract Full Text Full Text PDF PubMed Scopus (142) Google Scholar , 5 Good W.V. Early Treatment for Retinopathy of Prematurity Cooperative Group. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004; 102 (; discussion 48-50): 233-248 PubMed Google Scholar , 6 Stahl A. Lepore D. Fielder A. et al. Ranibizumab versus laser therapy for the treatment of very low birthweight infants with retinopathy of prematurity (RAINBOW): an open-label randomised controlled trial. Lancet. 2019; 394: 1551-1559 Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar , 7 Mintz-Hittner H.A. Kennedy K.A. Chuang A.Z. BEAT-ROP Cooperative GroupEfficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med. 2011; 364: 603-615 Crossref PubMed Scopus (987) Google Scholar We evaluated the use of laser and anti-VEGF and associated adverse outcomes from 2003 to 2020.

Factors associated with refractive outcome in children treated with bevacizumab for retinopathy of prematurity: the importance of retinal vascularization.

To evaluate the factors that may be associated with refractive outcome in eyes treated with intravitreal bevacizumab (IVB) injection for retinopathy of prematurity (ROP). Retrospective case series. Refractive outcomes of 181 infants who were treated with primary IVB for Type I ROP or aggressive ROP, were retrospectively evaluated. According to the pretreatment retinal vascularization, eyes were classified into zone I, zone I-zone II, and zone II groups. The first year, third year, and final refractive error were analyzed. Univariate logistic regression test was performed to evaluate the effect of factors on the development of ≥ 1 diopter (D) myopia. At the final examination, the mean age was 22.9 ± 10.9months. The zone II group was more hyperopic than the zone I-zone II and zone I zone groups (P = 0.001). Of the 331 eyes, 17 eyes (5.1%) had high myopia, 50 eyes (15.1%) had low myopia, and 83 eyes (25.1%) had emmetropia. During follow-up, 110 (33.2%) eyes underwent laser treatment. Gestational age, birth weight, neonatal intensive care unit type, the presence of additional laser treatment, number of injections, the type of ROP, and the dose of IVB were not associated with the development of ≥ 1 D myopia. The pretreatment and prelaser retinal zones were associated with the development of ≥ 1 D myopia. The most important factors affecting the refractive outcome in infants who underwent primary IVB treatment was the extent of pretreatment and prelaser retinal vascularization.

1-Year Fixed-Regimen Bevacizumab Treatment in DME-Vascular Network Image Analysis in Optical Coherence Tomography Angiography Study.

Purpose: To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using AngioTool software (version 0.6a(02.18.14), National Cancer Institute, Bethesda, Maryland). Methods: A total of 27 eyes in patients with treatment-naïve DME were included in this prospective study. OCT-A images with a scan area of 6 × 6 mm were obtained. The DME patients with a central macular thickness (CMT) of ≥300 µm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA) and CMT, were assessed. Explant area, vessels area, vessels percentage area, total number of junctions, total vessels length, average vessels length, the total number of endpoints, and mean lacunarity in the superficial capillary plexus (SCP) were calculated by using AngioTool software. Results: Twenty-nine eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 401.84 ± 84.54 µm to 328.93 ± 87.17 µm and improved BCVA from 65.18 ± 8.21 at baseline to 72.63 ± 7.43 letters among participants of the study. The anti-VEGF therapy showed no statistically significant changes in parameters calculated by AngioTool software in the study group of patients. Conclusion: The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. AngioTool software is an additional tool that could be used to assess vascular networks. However, the use of OCTA is unlikely to alter DME treatment regimens significantly or to find significant predictors. Perhaps using wide-angle devices or software will give a complete picture of the disease and prove to be more helpful.

Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography.

Purpose To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). Methods This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 μm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. Results Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 μm (±77.15) to 350.25 μm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 (p < 0.001) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 (p < 0.001), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 (p < 0.001) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 (p = 0.001). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. Conclusion The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.

Intravitreal Bevacizumab Alone Versus Intravitreal Bevacizumab In Combination With Focal Macular Photocoagulation In Diabetic Macular Oedema.

To compare the mean best corrected visual acuity (BCVA) between intravitreal bevacizumab (IVB) and combination treatment bevacizumab and Focal Macular Photocoagulation (FMP) for diabetic macular oedema (DME). It is a randomized control trial conducted at Department of ophthalmology at Institute of Ophthalmology, Liaquat University of medical and health sciences, Jamshoro from 1st November 2019 to 31st October 2020, in which 260 Patients between the ages of 40 to 75 years, with DME were included. While patients with macular oedema secondary to other causes than diabetic retinopathy, presence of vitreomacular traction, aphakic patients, history of glaucoma or who had received pan-retinal photocoagulation, IVB, triamcinolone within 12 months, patients with history of stroke or cardiac disease, patients with media opacities such as corneal opacities were also excluded from the study. Two hundred sixty (260) patients were divided in two groups. Group A has 130 patients and they were treated with IVB alone. Group B also included 130, and they were treated with combination of IVB+FMP. The patients were followed-up monthly for 3 months and BCVA was checked at the end of 3 months. Patients in group B showed superior visual outcome, when they were treated with IVB+FMC as compared to patients in group A who received IVB alone. Combination treatment OF IVB+FMP is an effective treatment option for diabetic macular oedema as compared to IVB alone with better mean visual outcome.

FOVEAL MÜLLER CELL CONE AS A PROGNOSTIC OPTICAL COHERENCE TOMOGRAPHY BIOMARKER FOR INITIAL RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN CYSTOID DIABETIC MACULAR EDEMA.

To investigate the effect of the foveal Müller cell cone structure on the anatomical and functional response to intravitreal bevacizumab treatment in patients with diabetic macular edema. In 93 treatment-naive eyes with center-involved cystic type diabetic macular edema, spectral-domain optical coherence tomography scans of baseline were retrospectively evaluated to determine the foveal Müller cell cone structure and prognostic features including length of disorganization in the retinal inner layers and ellipsoid zone disruption. The area and circularity of the foveal avascular zone of the superficial and deep capillary plexus 1 month after intravitreal bevacizumab treatment were evaluated using optical coherence tomography angiography. Destruction of the foveal Müller cell cone structure and a large foveal avascular zone in the deep capillary plexus (mm2) correlated strongly with a poor anatomical response (CST > 250 µm) at 1 month after first intravitreal bevacizumab (Exp [B] = 29.444, P = 0.002 and Exp [B] = 12.419, P = 0.013, respectively). A destroyed Müller cell cone structure (P = 0.008) and length of ellipsoid zone disruption (P < 0.001) at baseline were associated with poor visual acuity at 1 month after the first intravitreal bevacizumab. The foveal Müller cell cone structure correlates with the response to initial antivascular endothelial growth factor treatment.