Age-related macular degeneration (AMD) is a multifactorial disease that leads to progressive central vision loss. Bevacizumab (Avastin), a therapeutic agent used in the treatment of AMD, exerts its effect by binding to all isoforms of vascular endothelial growth factor (VEGF), thereby inhibiting angiogenesis. This study aimed to investigate the effects of Bevacizumab on immune system cells in the context of neovascular AMD (nAMD) treatment. Patients with nAMD receiving Bevacizumab treatment (n = 18) and a control group of individuals undergoing cataract surgery (n = 19) were included in the study. Peripheral blood samples were collected from nAMD patients before Bevacizumab treatment (baseline, 0 month) and after three monthly intravitreal injections. Following staining with monoclonal antibodies, innate immune cell, T cell, and B cell subsets were analyzed using flow cytometry panels. In the innate immune cell subsets of patients with neovascular AMD (nAMD), immature and suppressive neutrophils were significantly increased, whereas intermediate and non-classical monocytes were significantly decreased. Following intravitreal bevacizumab (IVB) treatment, these cell populations tended to return toward baseline levels. In the adaptive immune compartment, effector memory (EM) T cell subsets, particularly EM1 (effector memory 1) and EM3 (effector memory 3), exhibited opposing dynamics, showing significant changes both before and after IVB treatment. In conclusion, the findings from this study provide preliminary evidence that various immune cell subsets in both innate and adaptive compartments show associations with AMD pathogenesis and with IVB treatment.

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness in both developed and developing countries. With the advancement of neonatal health services, premature babies are now surviving more and at the same time the incidence of retinopathy of prematurity is increasing simultaneously. The aim of this study was to find out the frequency and risk factors of retinopathy of prematurity in neonates in NICU of Mymensingh Medical College Hospital (MMCH), Bangladesh. This was a prospective observational study and was carried out in the Department of Neonatology, MMCH, Bangladesh with the collaboration of Dr K Zaman BNSB Eye Hospital, Mymensingh from July 2020 to June 2022. Considering all inclusion and exclusion criteria, total 171 neonates were evaluated in this study. ROP screening was performed as per Bangladesh Medical University (BMU) protocol. Among 171 study neonates, 47 developed ROP. The overall frequency of retinopathy of prematurity was 27.5%. Stage 1-4 ROP was identified across affected neonates, with most in stage 2 and zone I plus disease occurred in 21 cases and AP-ROP in 14. In this study frequency of ROP was higher in <1000gms birth weight group. Among affected infants, 31.9% required intravitreal bevacizumab, while most (61.7%) needed follow-up only. Among 47 ROP patients, 18 received treatment and 29 patients needed follow up. The overall frequency of ROP was 27.5%. All ROP patients had immediate good outcome. Early screening, timely intervention and strict monitoring of high-risk neonates can significantly reduce vision-threatening complications and long-term childhood blindness.

This study aimed to evaluate the incidence and risk factors of reactivation following intravitreal bevacizumab (IVB) treatment for retinopathy of prematurity (ROP) and to determine which cases required additional treatment. A retrospective cohort study was conducted including 62 premature infants (119 eyes) diagnosed with type 1 ROP or aggressive ROP (A-ROP) who received IVB monotherapy between September 2021 and July 2024. Demographic and clinical parameters such as gestational age, birth weight, disease zone and stage, duration of oxygen therapy, and timing of IVB administration were analyzed. Reactivation and retreatment rates were compared to identify potential risk factors. Reactivation occurred in 36 eyes (30.3%), and 31 of these eyes (86.1%) required additional treatment. The mean gestational age and birth weight in reactivated eyes were 24.4 ± 1.2 weeks and 643 ± 149g, respectively. Reactivation was significantly associated with lower gestational age (p < 0.001), lower birth weight (p < 0.001), longer pre- and post-IVB oxygen therapy (p = 0.006 and p < 0.001), zone 1 disease (p < 0.001), and the presence of A-ROP (p < 0.001). Reactivation developed on average 9.4 weeks after IVB administration. Female infants showed a higher proportion of treatment-requiring reactivation (p = 0.031). Reactivation following IVB therapy is common among infants with low gestational age, low birth weight, prolonged oxygen exposure, and aggressive or zone 1 disease. Although most reactivations required retreatment, some resolved spontaneously, highlighting the importance of individualized and extended post-treatment monitoring.

This study aimed to evaluate the indications and real-world treatment outcomes of intravitreal bevacizumab in a resource-limited community eye hospital setting. This retrospective study included patients who received IVB injection at Hetauda Community Eye Hospital between January 2019 and December 2022. [Formula: see text]1 IVB injection; retinal diagnosis confirmed clinically and by Optical Coherence Tomography (OCT) where available. missing baseline Visual Acuity (VA) or OCT,[Formula: see text] month follow-up. Median visual acuity (VA) and central macular thickness (CMT) changes were compared using Wilcoxon signed‑rank test. A total of 418 injections were administered to 247 patients (260 eyes). After excluding those lost to follow‑up, 221 patients (234 eyes) were included in the analysis. Median baseline CMT was 366μm and improved to 236μm (p < 0.001). Most patients received one injection (57%) followed by two injections (30%). The median baseline VA was 0.78 log MAR and remained 0.78 log MAR overall (p = 0.108), but subgroup improvements were significant in DME, nAMD, BRVO, and central retinal vein occlusion (CRVO). IVB resulted in significant anatomical and functional improvements in patients with retinal diseases. The findings reflect real‑world outcomes in a community‑level eye hospital, where cost barriers limit repeated injections. The limitations of this study include its retrospective design, variable follow‑up, absence of control group, and limited numbers of injections.

(1) Background: Ultra-early optical coherence tomography (OCT) changes following intravitreal injection may reflect transient mechanical compression rather than pharmacologic effects; however, this temporal profile has not been rigorously characterised with appropriate statistical methodology. (2) Methods: In this prospective observational study, 40 eyes of 40 consecutive patients (one per patient) with macular edema secondary to neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or chronic central serous retinopathy (CSR) underwent intravitreal bevacizumab (n = 35) or triamcinolone acetonide (n = 5). Goldmann applanation tonometry and spectral-domain OCT were performed at baseline, 2-5 min, 15 ± 5 min, 24 h, and 48 h post-injection. Repeated-measures ANOVA with Greenhouse-Geisser correction, linear regression, and Spearman rank correlation were applied. (3) Results: Central subfield thickness (CST) decreased markedly at 15 ± 5 min (mean -24.8 ± 11.5%; 95% CI: -28.5% to -21.1%; p < 0.001; partial η2 = 0.70), with near-complete rebound by 48 h (-1.0%; p = 0.400). Peak intraocular pressure (IOP) elevation correlated with CST reduction (Spearman rs = 0.61; 95% CI: 0.39-0.77; p < 0.001), and baseline CST predicted thinning magnitude (R2 = 0.52; p < 0.001). (4) Conclusions: Ultra-early OCT thinning after intravitreal injection is consistent with transient mechanical compression. Retinal thickness measurements within 48 h post-injection should be interpreted with caution when assessing treatment response, as early anatomic reduction may not reflect pharmacologic efficacy.

To determine the efficacy of intravitreal bevacizumab (IVB) monotherapy versus a combination of IVB and suprachoroidal triamcinolone acetonide (SCTA) followed by monthly IVB in pseudophakic eyes with center-involving diabetic macular edema (DME). The Ophthalmology Department of Khyber Teaching Hospital conducted this randomized controlled study between April 2023 to February 2024. Eighty-two pseudophakic patients with center-involving DME were randomly divided into two groups (41 each). The monotherapy group (Group-I) received a monthly injection of IVB (1.25mg/0.05 mL) for three months. The combination therapy group (Group-II) received combination of IVB (1.25 mg/0.05 mL) and SCTA (4 mg/0.1 mL) injections at first visit which were then followed by monthly IVB injection for next two months. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and at four months. Both groups showed statistically significant improvement in BCVA and CMT from baselines. In Group-I, BCVA improved from 0.90±0.31 to 0.69±0.31 (p<0.001), and CMT decreased from 385.12±68.51 µm to 329.22±55.70 µm (p<0.001). In Group-II, BCVA improved from 0.84±0.28 to 0.52±0.21 (p<0.001), while CMT decreased from 382.49±63.32 µm to 292.46±32.24 µm (p<0.001). When compared between the groups, Group-II showed statistically significant improvement both in BCVA (p=0.034) and CMT (p<0.001). In pseudophakic patients with center-involving DME, a single combined treatment with SCTA and IVB yields better anatomical response and visual improvements as compared to IVB monotherapy. This combination approach might provide more therapeutic efficacy in terms of reducing macular edema. RCT Registration No.: ClinicalTrials.gov. (NCT06882551).

Retinopathy of prematurity (ROP) is the leading cause of childhood blindness worldwide. While choroidal involution has been described in animal models, choroidal perfusion in premature infants remains poorly characterized because of limited use of intravenous fluorescein angiography (IVFA). This retrospective study systematically analyzed IVFAs performed post-treatment in patients with ROP at the Hospital for Sick Children between 2011 and 2020. Eligible patients had received intravitreal bevacizumab or laser photocoagulation, and only transiting eyes were included to allow complete IVFA phase analysis. Three independent experts graded each IVFA for image quality, presence of delayed choroidal perfusion during the arteriovenous phase, and its location (central, peripheral, or multifocal). Inter-rater reliability was assessed using Fleiss's κ. Of 79 IVFAs reviewed, 74 met quality criteria. The cohort had an average birth weight of 602.6 g and a gestational age of 24.0 weeks. Most (63.5%) had zone I, stage 3+ ROP. IVFAs were conducted at a corrected age of 7.5 months. Delayed choroidal perfusion was found in 64 eyes (86.5%), predominantly multifocal. Only 2 eyes had normal perfusion. Inter-rater agreement was high (κ = 0.85). Delayed choroidal perfusion is common and persistent in treated ROP patients. To our knowledge, this is the largest IVFA series that systematically describes this underrecognized feature with implications for long-term vision.

To describe a case in which a retinal lesion mimicking cytomegalovirus (CMV) retinitis prompted investigation that revealed severe hypertriglyceridemia as an associated factor in exudative diabetic and radiation retinopathy. Observational case report with multimodal imaging and aqueous PCR analysis. A 38-year-old man with a history of leukemia, bone marrow transplantation, ocular and whole boddy irradiation, and type 1 diabetes presented for routine follow-up. A new granular retinal lesion raised suspicion for viral retinitis. Aqueous PCR testing for CMV, HSV, and VZV were negative. Systemic evaluation subsequently demonstrated triglycerides of 2,496 mg/dL. The findings were consistent with severe exudative diabetic and radiation retinopathy in the setting of extreme hypertriglyceridemia. He was treated with intravitreal bevacizumab and lipid-lowering therapy with observed improvement in retinal exudation, hemorrhages, and lipemia retinalis. A retinal lesion resembling CMV retinitis led to recognition of marked dyslipidemia associated with exudative retinopathy. Clinicians should be aware that dense, confluent exudation may mimic viral necrosis, and systemic lipid assessment is warranted in such cases.

Intravitreal Bevacizumab Improves Trabeculectomy Survival at 3 Years: Long-term Follow-up from the Bevacizumab in Trabeculectomy Study.

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is widely used for neovascular retinal diseases. Intraocular inflammation is a recognized adverse event and typically occurs in the injected eye. Inflammation in the fellow, uninjected eye is exceptionally rare and may be misinterpreted as sterile immune-mediated inflammation, potentially delaying appropriate treatment. We report a case of polymerase chain reaction (PCR)-confirmed herpes simplex virus type 1 (HSV-1) uveitis presenting in the fellow eye shortly after intravitreal bevacizumab administration. An 84-year-old man with well-controlled type 2 diabetes mellitus received intravitreal bevacizumab (1.25 mg) in the left eye for neovascular age-related macular degeneration. Three days later, he developed acute granulomatous anterior uveitis with dense vitritis in the right, uninjected eye, while the treated eye remained quiescent. Best-corrected visual acuity decreased to 20/400. Given the severity of inflammation and limited fundus visualization, viral retinitis was suspected. Empirical systemic valacyclovir and topical corticosteroids were initiated. Aqueous humor PCR detected HSV-1 DNA, confirming herpetic uveitis. Inflammation resolved within 40 days with recovery of visual acuity to 20/20 and no progression to acute retinal necrosis. The patient remained recurrence-free under antiviral prophylaxis at last follow-up. Severe fellow-eye inflammation following intravitreal bevacizumab may reflect viral reactivation rather than sterile inflammation. Early diagnostic evaluation, including aqueous humor PCR when clinically indicated, is essential to guide appropriate therapy and prevent sight-threatening complications.

Little is known about compliance with intravitreal anti-vascular endothelial growth factor (VEGF) therapy for the treatment of macular and retinovascular diseases among Nigerians and Africans. The objective of this study is to measure compliance to 3 or more and 6 or more intravitreal anti-VEGF injections for common macular and retinovascular diseases in Nigerian clinics and evaluate the impact on visual outcomes. Retrospective multicenter chart review of 622 eyes/ 528 patients diagnosed with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusions (RVOs), including branch, central, and hemiretinal (BRVO, CRVO, and HRVO), and non-AMD Choroidal Neovascular Membrane (CNVM) from five clinics (urban, semi-urban, and rural), collecting demographics, diagnosis, injection type/number, pre-/post-BCVA (converted to LogMAR), and follow-up. Treatments were intravitreal Bevacizumab (Avastin), Ranibizumab (Patizra), and Aflibercept (Eylea). Definitions of compliance: compliant; ≥3 injections (standard loading), also ≥ 6 injections. For all 622 eyes, presenting BCVA: 1.21 ± 0.84 and the final BCVA: 0.91 ± 0.80 (P = < 0.001). Overall compliance with ≥ 3 injections was 47.5%, and with ≥ 6 injections, 10.1%. Compliance to ≥ 3 injections by diagnosis was as follows: AMD 50.4%, Non-AMD CNVM 58.2%, BRVO 44.8%, CRVO 44.0%, HRVO 46.7%, DME 40.6%. Age (P = 0.264) and sex (P = 0.870) did not affect compliance to ≥ 3 injections. Clinic location significantly influenced compliance with ≥ 3 injections (P = 0.000), but not with 6 injections (P = 0.173). The highest rates of compliance with ≥ 3 injections were observed in urban tertiary centers. Injection type and cost were not significant factors (P = 0.36). Eyes with ≥ 3 injections achieved better vision (≥ 6/18) across all diagnoses; the most notable improvements were in non-AMD CNVM (+ 41.4%) and BRVO (+ 35%). Statistically significant LogMAR improvements were seen in CRVO (p = 0.049) and DME (p = 0.043). Postoperative endophthalmitis occurred in 2/622 eyes (0.0032) (both Avastin); no other serious adverse event was recorded. Real-world compliance is significantly lower than ideal. Urban and tertiary clinics show better adherence. Receiving the recommended loading doses is associated with improved visual outcomes for most diagnoses. Understanding the reasons for non-compliance, using a prospective approach, and addressing them will improve treatment outcomes for more Nigerian and presumably African patients receiving anti-VEGF drugs.

Purpose: The purpose of this study was to characterize the distribution and longitudinal evolution of intraretinal and subretinal hyperreflective foci (HF) in treatment-naive neovascular age-related macular degeneration (nAMD), and to examine associations between HF burden, hyperreflective material boundary remodeling (HRM-BR), and best-corrected visual acuity (BCVA) outcomes following bevacizumab treat-and-extend therapy. Methods: This was a retrospective observational study of 84 treatment-naive nAMD eyes receiving intravitreal bevacizumab via a treat-and-extend protocol. Spectral-domain OCT (Revo FC, Optopol) was performed at baseline (M0), month 3 (M3), and month 6 (M6). HF were quantified in the intraretinal and subretinal compartments using ImageJ software (version 1.54, National Institutes of Health, Bethesda, MD, USA) by two masked graders, with inter-rater agreement assessed by intraclass correlation coefficient (ICC). Eyes were classified into four HRM evolution patterns following the framework of Yu et al. Primary outcome was BCVA change from M0 to M6. Multivariable linear regression was performed to assess independent predictors of BCVA change. Results: Baseline intraretinal HF counts increased significantly across HRM Patterns 1 through 4 (median 0, 6, 4, and 8, respectively; Kruskal–Wallis p < 0.001; 95% CI for Spearman r = 0.471: [0.286, 0.623]). A higher baseline intraretinal HF count correlated with worse BCVA change at M6 (r = −0.300, 95% CI [−0.483, −0.092], p_adj = 0.010). In the primary multivariable model (n = 67), both intraretinal HF burden (β = −0.449, 95% CI [−0.879, −0.020], p = 0.041) and HRM width (β = −0.003, 95% CI [−0.005, −0.001], p = 0.014) were independent predictors of BCVA change. The transient M3 intraretinal HF peak in Pattern 3 eyes (median 4 → 12 → 4) was statistically confirmed by Wilcoxon signed-rank testing (M0 → M3: p = 0.004; M3 → M6: p = 0.001). Conclusions: Intraretinal HF burden is a graded marker of HRM pattern severity and an independent predictor of visual outcomes in nAMD, alongside HRM width. The statistically validated transient M3 HF peak in Pattern 3 may represent an early OCT signal of active boundary remodeling.

Simulation of retinal drug concentrations after intravitreal administration is still challenging, due to knowledge gaps in ocular physiology such as the molecule-dependent permeability of ocular segments and the mechanisms determining a drugs' diffusion through the vitreous. Current models consider the eye as an isolated organ, however, especially if we are striving for predictions that rely on only plasma data, it is crucial to understand the blood-ocular barrier to draw conclusions for drug exposure in the eye. The aim of this study was (1) to examine large molecule disposition within the rabbit injected eye as well as in the systemic circulation and the uninjected fellow eye using bevacizumab as a tool compound, (2) to show gaps in the current understanding of physiological processes governing drug distribution in the eye and (3) to identify model parameters relevant for eye-plasma drug exchange. We developed a semimechanistic ocular compartmental model to describe large molecule disposition in injected eye, plasma and fellow eye, following intravitreal bevacizumab administration in rabbit, based on literature data. Observations in the fellow eye add additional value to the developed model as they provide valuable new information about the blood-ocular barrier. Starting with a base model building on literature assumptions, we refined the structural model and parameter estimates (e.g., by adjusting the retinal volume) to better describe the observed data in the fellow eye. The simulated concentration-time profiles from our refined model adequately described observed concentrations in the injected eye, plasma and fellow eye. The retinal volume fraction accessible for bevacizumab was estimated at 41% and the retinal pigment epithelium permeability at 5.9 · 10-9 cm·s-1, which is in close agreement with the values obtained from in vitro experiments. The introduction of a backflow from the plasma compartment to the aqueous chamber (0.024 mL·day-1) yielded improved predicted aqueous concentrations in the fellow eye. The developed model increases our knowledge of ocular drug pharmacokinetics within a systemic context, with a more physiological representation of the retinal compartment and new insights into the processes involved at the blood-ocular barrier.

Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) share overlapping mechanisms involving oxidative stress, inflammation, and aberrant angiogenesis. Mesenchymal stem cell (MSC) therapy has shown promise in the treatment of BPD through paracrine modulation and anti-inflammatory effects, but its influence on retinal vascular development remains uncertain. This retrospective case series included five extremely low birth weight (ELBW) infants (<1000 g) who received allogeneic umbilical cord–derived MSC therapy for severe BPD between October 2021 and May 2023. Each infant received intravenous (2 × 10⁶ cells/kg) and intratracheal (1 × 10⁷ cells/kg) MSC administration in a single session. ROP screening and treatment were conducted in accordance with national guidelines. Clinical data and ocular outcomes were analyzed descriptively. The mean gestational age was 26²/₇ weeks (range, 25–28³/₇) and the mean birth weight was 810 g (580–1060 g). MSC therapy was given between postnatal days 36–126 (mean, 74 days). No systemic or ocular complications occurred during hospitalization or follow-up. One infant had no ROP, one developed Type 2 ROP with spontaneous regression, and three developed Type 1 ROP requiring intravitreal bevacizumab. All treated cases achieved complete regression after a single intravitreal bevacizumab injection, without recurrence, repeat injection, or need for laser therapy. MSC therapy appeared clinically safe in ELBW infants with BPD, with no adverse ocular effects. However, ROP developed in most infants despite MSC treatment, suggesting that MSCs do not prevent disease onset. The potential modulatory role of MSCs on retinal angiogenesis warrants further investigation through larger, controlled trials.

This study evaluated the clinical outcomes of intravitreal bevacizumab (IVB) in neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy (PDR) and investigated the association between serial aqueous vascular endothelial growth factor (VEGF) levels and treatment outcomes. A prospective single-arm observational study included 17 patients with NVG due to PDR. All patients received three bi-weekly IVB injections. Aqueous VEGF levels, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured before and after each injection. After the initial three injections, additional IVB injections were administered on a pro re nata (PRN) basis if IOP exceeded 21 mmHg or if iris or angle neovascularization persisted or recurred. Patients were followed for up to 3 years. After three injections, mean VEGF levels significantly decreased from 4681.46 pg/mL to 104.55 pg/mL (P < 0.001). BCVA improved (1.27 to 0.91 LogMAR, P < 0.001), and IOP decreased from (32.71 to 25.29 mmHg, p = 0.031). Higher baseline VEGF levels were significantly associated with worse BCVA and elevated IOP after treatment, as well as more frequent injections. Patients requiring six or more injections showed significantly higher baseline VEGF levels and poorer clinical outcomes compared to those requiring five or fewer injections. Serial aqueous VEGF levels were significantly associated with clinical outcomes and treatment burden in NVG secondary to PDR. Aqueous VEGF may serve as a potential surrogate marker reflecting disease severity and therapeutic response.

Background: Secondary full-thickness macular hole (FTMH) in proliferative diabetic retinopathy (PDR) is rare, occurring in only 1-4% of PDR cases. Combined with tractional retinal detachment (TRD), this complication presents significant surgical challenges. The inverted internal limiting membrane (ILM) flap technique remains under-utilized in this specific setting. Case presentation: A 61-year-old Indonesian male with type 2 diabetes (&gt;15 years), chronic kidney disease, and cardiovascular disease presented with sudden vision loss (best-corrected visual acuity 1/300). Examination revealed superior TRD (2-11 o'clock) and large FTMH (CMT 249 micrometers). After intravitreal bevacizumab (August 9th, 2024), he underwent 360-degree pars plana vitrectomy with inverted ILM flap and silicone oil tamponade (August 14th, 2024). Inferior redetachment at 2 months necessitated re-vitrectomy with endolaser and silicone oil evacuation (October 23rd, 2024). At final follow-up (12 weeks post-second surgery), the patient achieved complete retinal reattachment with normalized macular anatomy, visual acuity 1/60, and intraocular pressure 10 mmHg. Conclusion: Despite severe baseline disease and comorbidities, stepwise surgical strategy incorporating preoperative anti-VEGF therapy, comprehensive traction release, inverted ILM flap reconstruction, and staged procedures yielded meaningful anatomical recovery. This case supports inverted ILM flap utility in PDR-related secondary FTMH.

Combined anti-VEGF approach in neovascular glaucoma: clinical outcomes of intracameral and intravitreal bevacizumab administration

Purpose: To evaluate the impact of spectral-domain optical coherence tomography (SD-OCT) evaluation for maculopathy in eyes with retinoblastoma treated with external beam radiation coupled with targeted intravitreal antivascular endothelial growth factor (bevacizumab) on the treatment of radiation retinopathy. Methods: This is an institutional review board-approved, retrospective analysis of a consecutive case series of eyes with post-external beam radiation regressed retinoblastoma developing SD-OCT-confirmed retinopathy and documented visual decline. All patients were treated with external beam radiotherapy (40-50 Gy in 1.8-2.0 Gy fractions) prior to inclusion. Intravitreal bevacizumab 1.25 mg was injected in all eyes that met the inclusion criteria. All patients were treated with a primary treat-and-adjust schedule focused initially on a 6-week interval. Results: Nineteen subjects (11 male, 8 female) were included, with a mean follow-up of 40 months (range, 30-66 months). A total of 30 eyes met the inclusion criteria. After treatment, the mean SD-OCT central subfield foveal thickness of the entire cohort decreased from 511 μm at baseline to 389 μm by month 2, and 263 μm by year 2. Mean cohort intravitreal injections of bevacizumab totaled 8.2 during the first year, 7.6 during the third year, and 5.9 during the fifth year. Conclusions: This study offers new medical evidence suggesting that early diagnosis and antivascular endothelial growth factor therapy may improve visual outcomes in pediatric radiation retinopathy. Intravitreal bevacizumab improved visual acuity and anatomy in pediatric eyes with stable retinoblastoma and radiation maculopathy.

To evaluate long-term outcomes of photocoagulation (PC) and intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP). Retrospective paired-eye comparison. Twenty-one patients (42 eyes) treated for ROP between 2009-2010 were included. In each subject, one eye received PC and the fellow IVB. Visual acuity (VA), refraction (spherical equivalent [SE], cylinder power [CP], corneal astigmatism [CA]), and ocular biometry (corneal curvature radius, anterior chamber depth [ACD], lens thickness [LT], and axial length [AL]) were assessed at corrected ages of 1, 5, and 9 years. Cross-sectional differences were analyzed using the Wilcoxon signed-rank test, with Bonferroni correction applied at 9 years. Annual rates of change were evaluated using a linear mixed-effects model (LMM). Inter-treatment differences were assessed using Spearman correlation analysis. At 9 years, PC-treated eyes showed significantly worse VA, greater myopia, and shorter AL (all p < 0.05). ACD was deeper in IVB-treated eyes, while CP and CA were greater in PC-treated eyes. LMM revealed a significantly faster progression of myopia and CP in PC-treated eyes. Conversely, the annual rates of ACD deepening and LT thinning were significantly faster in IVB-treated eyes, whereas no significant differences were observed for VA or AL. Inter-treatment differences in SE were significantly correlated with AL differences, whereas VA differences were correlated with ACD. IVB-treated eyes showed better VA, less myopia, and more favorable refractive and biometric parameters. SE differences were associated with AL, whereas VA differences were associated with ACD, indicating distinct structural mechanisms.

Purpose: To evaluate the financial impact of monotherapy with intravitreal (IVT) bevacizumab and compare it with a combined approach of panretinal photocoagulation (PRP) and IVT bevacizumab for the treatment of retinopathy of prematurity in the United States. Methods: Data from 122 eyes of 71 infants initially treated with IVT bevacizumab monotherapy (Group 1) or IVT bevacizumab with PRP (Group 2) were collected. The direct cumulative costs of examinations, PRP, IVT bevacizumab, examinations under anesthesia, fundus photography, and fluorescein angiography were reported. The costs for each service or procedure were extrapolated from Centers for Medicare & Medicaid Services. The physician, facility, and total costs of each service were calculated for both groups when using Avastin vials or bottles. Results: Following the ideal American Academy of Pediatrics guidelines, the mean number of inpatient and outpatient examinations for Group 1 infants was 12.10 and 10.74, respectively, and was 9.97 and 2.12 for Group 2 infants, respectively. The average cost billed for all examinations and procedures was $5045.34 in Group 1 and $4349.92 in Group 2 when using Avastin vials. The largest share of total treatment costs in Group 1 was from subsequent inpatient visits, amounting to $1164.04 (23.07%). In contrast, the largest share of costs in Group 2 was for PRP, which totaled $1656.13 (38.07%). Conclusions: This study highlights that, compared with combined treatment of IVT bevacizumab and PRP, the direct cost of treating infants with IVT bevacizumab monotherapy is marginally increased and requires significantly more visits.