Intravitreal Bevacizumab Injection Research Articles

Spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture depicted on OCT angiography.

Choroidal rupture is a tear/break within the Bruch's membrane, retinal pigment epithelium and choroid following blunt trauma. Choroidal neovascularization is a well-known complication of traumatic choroidal rupture that is typically treated with intravitreal injections of Bevacizumab. This case describes an early detection of choroidal neovascular complex secondary to traumatic choroidal rupture and its spontaneous regression and quiescence without treatment followed using optical coherence tomography (OCT) angiography. A healthy 19 year old female presented with decreased vision in her left eye following a blunt non-penetrating closed globe injury two weeks prior. A complete ophthalmic examination with ancillary testing was consistent with sub-foveal choroidal neovascularization secondary to traumatic choroidal rupture. Five weeks later, there was spontaneous regression of the choroidal neovascular complex as depicted on OCT angiography and complete resolution of subretinal fluid/exudation on structural OCT. A conservative approach without intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections was chosen for management. To the authors' knowledge this is a first case describing a unique evolution with spontaneous regression and quiescence of choroidal neovascularization secondary to traumatic choroidal rupture without treatment followed using OCT angiography. Expectant management may be a viable treatment option for this condition.

Short-term Safety Evaluation of Resident-performed Intravitreal Injection

Purpose: This study evaluated the short-term safety of resident-performed intravitreal injections.Methods: We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection.Results: A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group.Conclusions: Resident-performed intravitreal injections appear to be safe.

Intravitreal bevacizumab treatment for exudative choroidal neovascularisation in best vitelliform macular dystrophy.

To describe results of intravitreal bevacizumab treatment of the secondary choroidal neovascularisation in Best vitelliform macular dystrophy in an adult and paediatric patient, and present the management of three asymptomatic patients with confirmed BEST1 gene mutation. Five patients from the same family with the Best vitelliform macular dystrophy are presented. In two patients (aged 63 and 4 years) secondary choroidal neovascularisation caused a rapid decline in visual acuity. In the adult patient with advanced Best vitelliform macular dystrophy, visual acuity did not improve despite eight intravitreal bevacizumab injections to the right eye. The formation of a central scar and rapid reoccurrence of choroidal neovascularisation three months after completing the initial treatment affected the outcome. As for the paediatric patient with bilateral choroidal neovascularisation in the vitelliform stage of Best vitelliform macular dystrophy, a complete recovery of visual acuity was observed after two (left eye) and three (right eye) bevacizumab injections, with adjunctive amblyopia treatment. The other three patients with an abnormal electrooculogram reported no visual problems during more than 10 years of follow-up. Minimal changes were seen on optical coherence tomography in the youngest patient. Intravitreal bevacizumab seems to be an effective treatment for exudative choroidal neovascularisation in the vitelliform stage of Best vitelliform macular dystrophy; however, it may not be beneficial in the advanced stages of Best vitelliform macular dystrophy. It is important to regularly screen all family members with an abnormal electrooculogram and confirmed mutation for vitelliform changes and choroidal neovascularisation from an early age. The decision for anti-vascular endothelial growth factor treatment should be made on a case-to-case basis as complications may arise.

Effect of intravitreal injection of bevacizumab in treated and untreated eyes of Black African patients with polypoidal choroidal vasculopathy

To evaluate the response of polypoidal choroidal vasculopathy (PCV) in eyes treated with intravitreal bevacizumab (BVZ) and untreated fellow eyes in black Africans. We studied 22 eyes (12 patients) divided into 12 treated and 10 untreated eyes from January 2017 to January 2020. Treated eyes received 1 monthly injection of BVZ 2.5mg for 3 months, with optional additional injections depending on the patient's course. Both groups of eyes were evaluated at presentation and then at 3, 6, 9, and 12 months after treatment. Outcome measures were visual acuity (VA) and ophthalmoscopic and OCT findings. The mean age of the patients was 66.3±5.6 years. In treated eyes, VA remained stable from 0.10±0.12 at baseline to 0.20±0.30 at month 12, P=0.84. VA was stable in 83.3% and improved in 16.7% of eyes. On OCT, 41.7% of eyes showed decreased and another 41.7% disappearance of subretinal fluid (SRF) at 12 months. Pigment epithelial detachment (PED) height decreased in 9 eyes (75.0%) but remained unchanged in 3 eyes (25%). In untreated eyes, no difference was observed between the baseline (0.53±0.42) and 12-month VA (0.58±0.40), P=0.82. VA improved in 2 eyes, decreased in one eye, and remained unchanged in 7 eyes. OCT lesions remained stable in 6 eyes. The PED enlarged in one eye but remained stable in 3 other eyes. Intravitreal injection of BVZ 2.5mg led to stabilization of VA, resorption of SRF, and reduction in the size of the PED in the majority of eyes with PCV but was ineffective on the polyps. The one-year prognosis in untreated eyes with PCV was favorable and marked by functional and structural stability.

P059 Etiological profile of childhood uveitis in a Tunisian population: a 12-year retrospective study

Abstract Background Uveitis in children represents 10% of all cases of uveitis. It is a serious condition with an often-insidious onset and evolution, and has a negative impact on visual prognosis with a risk of amblyopia or even blindness. The etiologies are varied. the aim of this study is to describe the epidemiological, clinical, and etiological characteristics of childhood uveitis during a period of 12 years. Methods A descriptive retrospective study including 138 children (276 eyes) with uveitis, was conducted at the Ophthalmology Department of Fattouma Bourguiba University Hospital in Monastir Tunisia between 1 January 2006 and 31 December 2017. Results The patients average age was 10.2 ± 3,58. A female predominance was noted (sex ratio: 0.91). Uveitis was bilateral in 2/3 of cases and unilateral in 1/3 of cases. Vision loss was the most common reason for consultation (52.2%). The mean initial visual acuity was 3,3/10 ± 3,24. Intermediate uveitis was the most common anatomical form (42,02%), followed by anterior uveitis (28,26%), panuveitis (26,08%), and posterior uveitis (3,6%). The infectious origin was the most common aetiology, followed by uveitis related to general condition (13,72%), and uveitis in context of a specific ocular condition (12,3%). Uveitis was idiopathic in 79 patients (57.24%). Periocular injection of triamcinolone acetonide was performed in (29 patients, 21%). The use of immunosuppressives agents was noted in 38 patients (27,5%) (methotrexate: 23 patients, azathioprine: 16 patients, and ciclosporin: 10 patients). The use of intravitreous injections of bevacizumab was noted in 6 patients (4.33%). Anti TNF alpha treatment was used for 2 patients. Post-uveitic complications were noted in 84.3% of cases. They were dominated by cataract (31,88%) at the anterior segment level. Cystoid macular oedema (31,88%) and retinal serous detachment (15,9%) were the major complications in the posterior segment. Mean final visual acuity was 5.98/10 ± 3,54. It was <1/10 in 14 eyes. Conclusion In our study a female predominance was noted. Intermediate uveitis was the most common anatomical form. The infectious origin was preponderant. Post-uveitic complications was dominated at the anterior segment level by cataract and cystoid macular oedema at the posterior segment.

EFFECT OF INTRAVITREAL TRIAMCINOLONE ACETONIDE IN REFRACTORY DIABETIC MACULAR EDEMA

Objective: To investigate the effects of intravitreal triamcinolone for refractory diabetic maculopathy after 03 unsuccessful intravitreal bevacizumab injections.
 Study Design: Prospective observational study.
 Place and Duration of Study: Retina department of Al-Shifa Trust Eye Hospital Rawalpindi, from Jun 2016 to Jul 2017.
 Methodology: Total 35 eyes of 35 patients who were diagnosed with diabetic maculopathy and having history of minimum three intravitreal Bevacizumab injections were included. Detailed eye examinations included visual acuity, anterior and posterior segment examination and intraocular pressure measurement was performed in all patients. Central macular thickness was also measured. Then intravitreal triamcinolone was administered to eyes by principal researcher (Ophthalmologist). After one month, follow up examination of patient’s eyes was done to assess the effects of injection.
 Results: Majority of the participants were males 19 (55%) in this research. There was statistically significant difference between means of intra ocular pressure (mean difference= 4.30 ± 5.41), Visual acuity (mean difference=2.8 ± 2.4) and central macular thickness (mean difference = 236.4 ± 13) pre and post injection was found (p-value<0.05).
 Conclusion: There was statistically significant difference of central macular thickness and visual acuity, pre and post intravitreal triamcinolone acetonide injection was found.

Intraocular Pressure–Related Events After Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal Vein Occlusion or Hemiretinal Vein Occlusion

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are used to treat a variety of posterior segment conditions, including some associated with glaucoma, such as macular edema due to central retinal vein occlusion (CRVO). Therefore, information regarding intraocular pressure (IOP)-related events associated with anti-VEGF therapies is important to help balance the risks and benefits over the course of therapy. To investigate IOP-related events among participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2). Secondary analysis of a randomized clinical trial that included 312 participants with macular edema secondary to CRVO or hemiretinal vein occlusion (HRVO) who were not taking IOP-lowering medications at baseline. First randomization occurred on September 14, 2014, and contained data through data freeze on April 1, 2020. Analysis took place from April 2020 through December 2020. Study participants were initially randomized to 6 monthly intravitreal injections of aflibercept or bevacizumab. At month 6, protocol-defined good responders were rerandomized to continued monthly or treat-and-extend dosing of their originally assigned study drug, and protocol-defined poor or marginal responders were switched to alternative treatment. After month 12, participants were treated as per investigator discretion. Three different outcomes: (1) IOP elevation more than 10 mm Hg from baseline, (2) IOP to a level higher than 35 mm Hg, and (3) IOP-lowering incisional or laser surgery. Of the 312 participants meeting inclusion criteria (138 [44.2%] were female; mean [SD] age, 67.8 [12.1] years), 25 (8.0%) had IOP elevation more than 10 mm Hg over baseline through month 60, and 5 (1.6%) had IOP higher than 35 mm Hg. The 60-month Kaplan-Meier cumulative incidence of IOP elevation more than 10 mm Hg over baseline was 0.13 (95% CI, 0.08-0.19), and the 60-month Kaplan-Meier cumulative incidence of IOP higher than 35 mm Hg was 0.02 (95% CI, 0.01-0.06), and did not differ among participants initially randomly assigned to receive aflibercept or bevacizumab. Three participants (1.0%) underwent IOP-lowering incisional surgery, and 3 participants (1.0%) underwent IOP-lowering glaucoma laser surgery. Intravitreal anti-VEGF injections are used to treat some conditions associated with glaucoma, such as macular edema due to CRVO, and the rates of IOP-related events in this trial support monitoring IOP in eyes treated with anti-VEGF therapy for macular edema associated with CRVO or HRVO for up to 60 months. ClinicalTrials.gov Identifier: NCT01969708.

Estimation of the Level of Glycosylated Hemoglobin as a Predictor Factor to Bevacizumab Injection in Diabetic Macular Edema in a Sample of Iraqi Patients

Abstract
 Background: clinically significant macular edema ( CSME) consider as one of the most critical complications of poorly controlled diabetes and it’s the main reason for decreased vision in that kind of patients, we try in this article to find the relation between glycosylated hemoglobin level and the response to bevacizumab injections in people with macular edema
 
 Materials and methods: Ninety-five patients (55 male:40 female) were recruited in this study, all of them had diabetes type2, age of the participants ranging from 42 to 70 years old, Complete ophthalmic examination was done for all the participants including (best-corrected visual acuity), (intraocular pressure) checking, fundus evaluation, and central macular thickness measurement, serum glycosylated hemoglobin (HbA1C) was also measured, Patients were given 0.05ml(1.25mg) of bevacizumab (Avastin) intravitreally for three successive months, Follow up visit was at 4,8,12 week post-injection. On each follow up detailed examination was done including the( best-corrected visual acuity) examination, (Intraocular pressure), both fundus examination, and OCT of the macula.
 Results: This study included 111 patients who had type 2 diabetes mellitus who were classified according to HbA1c into two sub-groups, HbA1c ≤ 7 % (n = 45) and HbA1c > 7 % (n = 66) we found no significant difference in mean age and frequency distribution according to gender between study groups (p > 0.05), but, there was a highly significant difference in mean HbA1c % (p < 0.001). when we compare mean OCT and mean VA before and after the intervention in patients who had diabetes mellitus classified according to HbA1c into (HbA1c ≤ 7 % and HbA1c > 7 %) we found that before the intervention, there was no significant difference in mean OCT between study groups (p > 0.05), but after the intervention, there was a reduction in mean OCT and the reduction was more pronounced in the group of HbA1c of less than 7 % (p < 0.001). About visual acuity, we found no significant difference before the intervention and after the intervention, the changes were comparable between both study groups (p > 0.05).
 Conclusion: intra-vitreal injections of bevacizumab result in anatomical (macular thickness) and functional (vision ) improvement in those patients who had diabetic macular edema and strict glycemic control affecting the outcome of the treatment where strict regulation of glucose level have yield maximum benefit from the given therapy 

Comparison of aflibercept and bevacizumab in the treatment of type 1 retinopathy of prematurity

BackgroundTo evaluate the outcome of intravitreal bevacizumab (IVB) and aflibercept (IVA) injection for patients with retinopathy of prematurity (ROP).MethodsIn this single-center retrospective cohort, the recorded medical data of the infants who had been undergone intravitreal injection with either bevacizumab or aflibercept for type 1 ROP were reviewed. The infants were allocated into two groups. IVB group included patients who were treated with bevacizumab as initial treatment and the IVA group included patients who were treated with aflibercept as initial treatment. The rate and time of complete regression, as well as the recurrence rates, were compared between the groups.ResultsA total of 889 eyes of 453 infants were enrolled in the study. There were 865 eyes of 441 infants in the IVB group and 24 eyes of 12 infants in the IVA group. Follow-up time was 289 ± 257 days in the IVB group and 143 ± 25 days in the IVA group (p < 0.001). The difference in the ROP zone was not statistically significant between the 2 treatment groups (p = 0.328). All eyes in the IVA group showed initial regression of ROP after the intravitreal injections. These regressions were achieved in 830 (96.0%) eyes that were injected with IVB (p = 0.023). The median observed regression time was 10 days and 16 days in eyes treated with bevacizumab and aflibercept respectively. Recurrence was noted in 3.9% of eyes (34/865) in the IVB group and 58.3% of eyes (14/24) in the IVA group (p < 0.001).ConclusionWhile the regression rate in the IVA group was significantly higher than in the IVB group, the recurrence rate was significantly more in the IVA group, which may be attributed to differences in the pharmacokinetics of these drugs in the vitreous body.

Baseline Subfoveal Choroidal Thickness as a Predictor for Response to Short-Term Intravitreal Bevacizumab Injections in Diabetic Macular Edema.

PurposeThis article aims to evaluate how the subfoveal choroidal thickness (SFCT) and best-corrected visual acuity (BCVA) respond to the intravitreal injection of bevacizumab and to assess the correlation between these changes. It will also assess the use of the baseline SFCT as a predictor for BCVA changes in eyes of treatment-naive, diabetic macular edema (DME) patients.MethodsThis retrospective, consecutive case series comprised 59 eyes of 39 treatment-naive DME patients. Complete slit-lamp assessment, swept-source optical coherence tomography (SS-OCT) scans to measure SFCT and BCVA values were performed at two stages: baseline and one month after the third monthly injection of intravitreal bevacizumab.ResultsPatients’ ages ranged from 46.3 to 76.4 years (mean: 62.6 ± 2.3). The mean SFCT was 318 ± 82 μm at baseline, which decreased after 3 months to 300 ± 66 μm (P-value = 0.021). There was an improvement in the mean of the logMAR best-corrected visual acuity (BCVA) from 0.7 (decimal equivalent: 0.2) to 0.5 (decimal equivalent: 0.3) (P-value = 0.019). There was no association between SFCT changes and BCVA changes (P-value = 0.180). Wilcoxon signed-rank test disclosed that a better BCVA improvement was related to a greater subfoveal choroidal thickness at baseline P-value <0.00.ConclusionEyes with a higher baseline subfoveal choroidal thickness (SFCT) attained greater BCVA improvement than eyes with a lower baseline SFCT. In addition to this, changes to SFCT do not appear to correlate with BCVA changes. These findings do not support using OCT SFCT changes as a prognostic factor for changes to BCVA after intravitreal bevacizumab treatment in evaluating treatment-naive DME eyes.

Cosmetic Nd:YAG Laser-assisted Maculopathy Treated with Early Anti-vascular Endothelial Growth Factor Antibody

Purpose: To report a follow up of early intravitreal anti-vascular endothelial growth factor (VEGF) antibody treatment in a patient with maculopathy after accidental exposure to a high-powered cosmetic Nd:YAG laser.Case summary: A 36-year-old female patient visited our clinic with decreased visual acuity in the right eye after accidental exposure to a high-powered cosmetic Nd:YAG laser. The best-corrected visual acuity of the right eye was 0.1 and subretinal hemorrhage on the foveal area was observed during fundus examination. Optical coherence tomography revealed serous retinal detachment with hyperreflective disruption of the ellipsoid zone and retinal pigment epithelium-Bruch’s membrane complex. Intravitreal bevacizumab (Avastin&lt;sup&gt;®&lt;/sup&gt;, 1.25 mg/0.05 mL; Roche Korea, Seoul, Korea) injections were performed three times. Visual acuity was unchanged at 6 months after the first visit. However, complete resolution of the subretinal hemorrhage was observed and there were no signs of secondary choroidal neovascularization or recurrence of choroidal hemorrhage.Conclusions: Early anti-VEGF antibody treatment in a patient with subfoveal hemorrhage and choroidal rupture after high-powered cosmetic Nd:YAG laser exposure improved morphology and prevented secondary choroidal neovascularization.

CENTRAL MACULAR THICKNESS AFTER COMBINED THERAPY OF BEVACIZUMAB INTRAVITREAL INJECTION AND TOPICAL DICLOFENAC COMPARED WITH BEVACIZUMAB INTRAVITREAL INJECTION ALONE IN DIABETIC MACULAR EDEMA

Introduction: To evaluate whether the combination of diclofenac eye drops and bevacizumab intravitreal injection would provide additional benefits over bevacizumab alone in the treatment of naïve diabetic macular edema (DME).&#x0D; Methods: A total of 43 patients were enrolled consecutively and randomized into two groups to receive combination treatment with intravitreal bevacizumab and topical diclofenac (group 1) or bevacizumab alone (group 2). Group 1 patients received single bevacizumab intravitreal injection and got self-administered diclofenac eye drop four times daily for one month. Group 2 patients received single bevacizumab intravitreal injection alone. Outcome data were obtained from patient visits at baseline and at 1 month after bevacizumab intravitreal injection. All patients underwent measurement of best corrected visual acuity (BCVA), a complete eye examination, and measurement of central macular thickness (CMT).&#x0D; Result: The mean reduction in CMT in the combination group was 130.42±32.57 µm (p&lt;0.01), while in the bevacizumab alone group the reduction was 141.38±45.27 µm (p&lt;0.01), there is no significant difference between the two groups (p=0.866). The mean improvement of BCVA was 0.32±0.10 log Mar in the combination group and 0.26±0.12 in group 2, there is no significant difference between the two groups (p=0.691). There was no adverse ocular event in the two groups.&#x0D; Conclusion: In patients with naïve DME, adding diclofenac eye drop as adjuvant of bevacizumab intravitreal injection are less likely to have a meaningful effect on reducing the central macular thickness.&#x0D; Keywords: Diabetic macular edema, NSAID, diclofenac, anti-VEGF, bevacizumab, central macular thickness

Multifocal Electroretinogram, Central Macula Thickness and Visual Acuity in Diabetic Macular Edema Following Intravitreal Injection of anti-VEGF

Introduction : Diabetic Retinopathy (DR) is one of the major cause of visual acuity deterioration in diabetic patients. The loss of central visual acuity in diabetic patients are mainly due to macula edema, which is found in 29% diabetic patients with the over 20 years duration of disease. The aim of this study is to evaluate and investigate the possible correlation among changes of visual acuity (VA), central macular thickness (CMT) using Spectral Domain Optical Coherence Tomography (SD-OCT). Electrophysiological responses using multifocal electroretinography (MfERG) in diabetic macular edema (DME) following intravitreal injection of bevacizumab.&#x0D; Methods: Single arm clinical trial. Thirty-three eyes of 33 DME patients (16 non-proliferative diabetic retinopathy and 17 non-high-risk proliferative diabetic retinopathy), receives intravitreal bevacizumab 1,25mg. All patients underwent complete ophthalmic examination including ETDRS VA testing, Sixty-one scaled hexagon MfERG and SD-OCT scan at baseline, 1-week and 1-month post-injection. Components of the first order kernel (N1, N2 and P1) in central 2o were measured.&#x0D; Result : MfERG showed reduced P1 amplitude (P&lt;0.05) at 1-week after injection followed by increased P1 amplitude (P&gt;0.05) at 1-month after treatment as compared to the baseline in all subjects. There was 19% improvement CMT and 0.2Logmar VA improvement in 1-month post-injection compared to the baseline (P&lt;005). This study showed no serious ocular adverse effects. There was no significant correlation between changes in visual acuity with changes in CMT or other MfERG parameters.&#x0D; Conclusion: Intravitreal injection bevacizumab resulting in improved VA, reduction in CMT and mild improvement in the MfERG responses. Although VA changes did not correlate with reduced CMT nor with improved responses of MfERG, the combined use of SD-OCT and MfERG may be used to evaluate macular function in DME patient with worsened visual acuity post anti-VEGF injection.

A Prospective Study of Safety Profile and Efficacy of three doses of Intravitreal Bevacizumab in Diabetic Macular Edema

Introduction: Current study aimed to evaluate efficacy of intravitreal Bevacizumab in Diabetic macular edema, and to identify their ocular and systemic complications if any.&#x0D; Method: It is a prospective, interventional study with 68 patients in 82 eyes with Diabetic macular edema. All treated by 3 injection of intravitreal bevacizumab with 1 month interval. Visual acuity, macular edema, and complications evaluated at every month upto 6th months. Ranibizumab was offered if the patient is a non-respondent to Bevacizumab.&#x0D; Results: Majority age group of 61-70 years with a mean age of 59 ± 6.72 years. The mean duration of diabetes was 11.68 ± 7.2 years. The mean baseline BCVA and CRT are 0.64 ± 0.28 Log MAR units and 436.99 ± 135.10 μm. After 3 injections, BCVA values are 0.48±0.27 (p&lt; 0.01)), 0.36±0.24 (p&lt;0.01)), and 0.27±0.24 (p&lt;0.01), 0.23±0.27 Log MAR (p&lt;0.01)) at 1month, 2 months, and 3 months, and 6 months follow-up respectively. CMT levels are 315.79±124.60 μ at 1 month, after 3rd IVA and this significant change (p&lt;0.01) followed with subsequent follow-up with mean CRT of 296.04±122.97 μ (p&lt; 0.01) at 6th month. The BCVA improved ≥ 2 Snellen lines in 69.5% and 78% cases, resolution of CMT in 56% and 69.5% cases at 3 months and 6 months respectively. At the end of the 3rd month, 46 eyes macular edema completely resolved with 3 injections of IVA, 23 eyes persistent macular edema present, 13 eyes refractory to bevacizumab injections. Persistent &amp; Refractory macular edema eyes (36) switched to Ranibizumab injections.In persistent macular edema, significant resolution (p≤0.01) of macular thickness (370.52 ± 71.43 µm vs. 341.08 ± 122.75 µm) without (p=0.09) improvement in visual acuity (0.45 ± 0.20 vs. 0.34 ± 0.23) was observed post Ranibizumab injections. In Refractory macular edema, thickness of cases no significant (497.76 ± 161.07µm vs 407.84 ± 169.64 µm) improvement seen after Ranibizumab injections(p=0.1). Recurrence of macular edema seen in 10.9%. Subconjunctival haemorrhage seen in 10.9%-12.1% cases, raised IOP in 2.4%-3.6% cases at post injection day 1. No other ocular and systemic complications were observed during follow-up.&#x0D; Conclusions: Intravitreal bevacizumab is effective in treatment of diabetic macular edema but therapeutic effect is temporary and repeat treatment is needed. It does not show any potential drug related ocular and systemic side effects, hence it is safe and economical therapeutic agent

Treatment Results of Bevacizumab for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (&lt;i&gt;p&lt;/i&gt; = 0.025, &lt;i&gt;p&lt;/i&gt; = 0.019, and &lt;i&gt;p&lt;/i&gt; = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (&lt;i&gt;p&lt;/i&gt; = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (&lt;i&gt;p&lt;/i&gt; = 0.044, &lt;i&gt;p&lt;/i&gt; = 0.047, &lt;i&gt;p&lt;/i&gt; = 0.004, &lt;i&gt;p&lt;/i&gt; = 0.045, and &lt;i&gt;p&lt;/i&gt; = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (&lt;i&gt;p&lt;/i&gt; = 0.045, &lt;i&gt;p&lt;/i&gt; = 0.046, &lt;i&gt;p&lt;/i&gt; = 0.002, and &lt;i&gt;p&lt;/i&gt; = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (&lt;i&gt;p&lt;/i&gt; = 0.042, &lt;i&gt;p&lt;/i&gt; = 0.009, and &lt;i&gt;p&lt;/i&gt; = 0.015, respectively). Conclusions: In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Optical Coherence Tomography Biomarkers Predicting Visual Acuity Change after Intravitreal Bevacizumab Injections for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: This study aimed to identify baseline optical coherence tomography (OCT) factors in branch retinal vein occlusion (BRVO) that predict response to bevacizumab injections. Methods: It is a retrospective case series of consecutive patients that underwent OCT at diagnosis, and the central macular thickness (CMT), extent of disorganized retinal inner layers, and outer retinal layers including external limiting membrane, ellipsoid zone (EZ), and cone outer segment tips (COST) were measured. Patients received 3 consecutive monthly injections of bevacizumab followed by pro re nata treatment. The main outcome measure was improvement in best-corrected visual acuity (BCVA) after 1 year. Results are expressed as mean ± SD, and p value <0.05 was considered statistically significant. Results: Overall, 66 eyes of 66 patients, with an average age of 68.5 ± 11.4 years, were included. The mean BCVA improved significantly from 0.68 logMAR at baseline to 0.50 logMAR at 1 year (p < 0.001). Baseline logMAR BCVA (r = 0.41, p < 0.001) and CMT (r = 0.23, p = 0.04) were associated with improvement while EZ (r = −0.24, p = 0.05) and COST (r = −0.32, p = 0.01) disruption with deterioration in BCVA. Conclusion: In patients with naïve BRVO treated with bevacizumab, BCVA improvement at 1 year can be predicted from baseline BCVA, CMT, extent of COST disruption, and EZ disruption.

Impact de la pandémie du SARS-CoV-2 sur l’œdème maculaire diabétique et facteurs pronostiques

ButDécrire le retentissement sur l’acuité visuelle et l’épaisseur centromaculaire après arrêt des injections intravitréennes d’anti-VEGF chez les patients diabétiques marocains au cours de la pandémie du Coronavirus. Et étudier les facteurs pouvant être associés à l’aggravation.Matériel et méthodesCette étude transversale monocentrique a inclus les patients programmés pour injections intravitréennes de Bevacizumab au cours de la période du confinement (20 mars 2020–20 mai 2020) et qui n’en ont pas bénéficié. Ont été recueillis : l’âge, le sexe, l’ancienneté du diabète, le nombre d’injections reçues avant le confinement, l’acuité visuelle en pré-confinement et post-confinement ainsi que l’épaisseur centromaculaire pré-confinement et post-confinement.RésultatsCent cinquante quatre yeux de 104 patients ont été analysés. 57,8 % étaient des hommes avec une moyenne d’âge de 59,4 ± 9,04 ans. La durée moyenne d’arrêt des injections intravitréennes est de 57,3 ± 6,7 jours. Le nombre moyen d’injections intravitréennes de Bevacizumab reçues avant le confinement a été estimé à 2,29 ± 2,1. L’aggravation de l’acuité visuelle a été notée chez 44,8 % de nos patients. Les facteurs associés à l’aggravation fonctionnelle sont le faible nombre d’injections intravitréennes de Bevacizumab reçues avant le confinement (p = 0,001) ainsi que le déséquilibre diabétique (p = 0,04). L’aggravation structurelle a été constatée chez 26,6 % des patients et elle était associée au faible nombre d’injections réalisées avant le confinement (p = 0,038).ConclusionLe report des injections intravitréennes au cours du confinement a eu des effets négatifs sur l’acuité visuelle et l’épaisseur centromaculaire des yeux avec OMD. Un report prolongé des injections intravitréennes d’anti-VEGF chez les patients diabétiques doit être évité.

Effect of Topical Versus Sub-conjunctival Anaesthesia during Administration of Intravitreal Bevacizumab Injection

Purpose: To compare the anesthetic effect of topical proparacaine hydrochloride 0.5% with sub-conjunctival lidocaine 2% for intravitreal injection of Bevacizumab.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of Ophthalmology Fauji Foundation Hospital, Rawalpindi, from July 2017 to January 2018.&#x0D; Methods: Sixty 60 patients who needed intravitreal Bevacizumab were included in the study after approval from the ethical review board. Exclusion criteria were patients with conditions that could affect pain sensation, acute ocular inflammation, history of intravitreal injection, using systemic analgesic/sedatives, uncooperative patients and unable to understand the pain scale. Written informed consent was taken. Name, age, gender, diagnosis, previous intravitreal injection, hospital registration number, address and contact numbers were noted. Patients were briefed about the visual analogue scale. Patients were divided into two groups. Group A received proparacaine drops and group B was given subconjunctival lidocaine injections before intravitreal bevacizumab.&#x0D; Results: The mean age of patients in this study was 60.38 ± 10.55 years. There were 03 (5.0%) males and 57 (95.0%) females. Majority of the patients (30%) presented with choroidal neovascularization followed by diabetic maculopathy, vitreous hemorrhage, central retinal vein occlusion and proliferative diabetic retinopathy. Mean pain score among both the groups was 3.67 ± 1.97 (topical group) and 1.70 ± 1.51 (sub-conjunctival group) respectively which was statistically significant (p-value 0.000). Among age, diabetes, duration of diabetes and hypertension, only hypertension had moderate correlation with the pain score (correlation coefficient = 0.316, p values = 0.017).&#x0D; Conclusion: Sub-conjunctival anaesthesia results in less pain during intravitreal drug administration as compared to the topical anaesthesia.&#x0D; Key Words: Intravitreal injections, Bevacizumab, Intravitreal Anti-VEGF, Anesthesia.

Use of Intravitreal Bevacizumab Injection among Patients Undergoing Surgical Retinal Interventions at Tertiary Eye Hospital: A Descriptive Cross-sectional Study.

Intravitreal Bevacizumab injection has now become a routine procedure for retina specialists throughout the world. Easy availability of this monoclonal antibody molecule even in Nepal has brought a revolution in the management of various retinal diseases. This study aims to find out the prevalence of the use of intravitreal Bevacizumab for retinal diseases at the tertiary eye hospital. This descriptive cross-sectional study was carried out in the retina department at a tertiary care hospital from January 2017 to December 2019 after obtaining ethical clearance from Nepal Health Research Council (Ref: 125/2020P). The sample size was calculated and the study enrolled all patients who received intravitreal Bevacizumab for retinal diseases using convenience sampling technique. Data were analyzed using Statistical Package for Social Science Version 21. Point estimate at 95% Confidence Interval was calculated, along with frequency and percentage for binary data. Out of 959 total surgical retinal interventions done 296 (30.86%) at 95% Confidence Interval (27.93-33.78) patients received intravitreal Bevacizumab. Out of total intravitreal Bevacizumab injections, 143 (36.7%) injections were given to retinal vein occlusions patients, 127 (32.6%) injections were given to diabetic retinopathy patients and 66 (17%) injections was given to age-related macular degeneration patients. Males 176 (59.5%) outnumbered the females 120 (40.5%) in receiving intravitreal Bevacizumab. Mean baseline Logarithm of the Minimal Angle of Resolution visual acuity, 1.1, improved to, 0.75, after 3 months of intravitreal Bevacizumab. Intravitreal Bevacizumab was one of the commonest retinal interventions used. Retinal vein occlusion, diabetic retinopathy, and age-related macular degeneration were the commonest retinal diseases needing intravitreal Bevacizumab.

Evaluation of vitreous cellular activity following per-operative Povidone-iodine alone and combined per-operative Povidone-iodine with topical antibiotic after Intravitreal injection of anti-vascular endothelial growth factor Bevacizumab for retinal pathologies

Abstract: Purpose: To assess the efficacy of per-operative 5% Povidone-iodine alone or in combination with post injection topical antibiotics for reducing vitreous activity in patients undergoing Intravitreal injection of anti-vascular endothelial growth factors Bevacizumab. Methods: Total of 114 enrolled patients with retinal medical pathologies requiring Intravitreal anti vascular growth factors were randomized to study group A (5% Povidone-iodine per operative on conjunctiva for 3 minutes) and group B (5% Povidone-iodine per-operative on conjunctiva for 3 minutes and post injection topical antibiotics fluroquinolone four times a day for a week) with 57 patients in each group. All Intravitreal injections were performed in operating room in a sterile manner. Vitreous activity assessed using Sun’s classification on slit lamp on first day and day 7 post Intravitreal injection of 1.25mg/0.05ml anti VEGF Bevacizumab. Collected data of group A and B was analyzed. Result: Out of 114 patients, 75 were males and 39 were females. Vitreous activity seen at day one post injection was same in both study groups while at day seven group A had increased vitreous cellular activity as compared to study group B. Both day one and day seven activity within the study groups were insignificant with p=0.244 and p=0.498 respectively. Conclusions: In both groups A and B, 5% Povidone-iodine (PI) solution shows effective prophylaxis against Endophthalmitis in Intravitreal anti VEGF injections. Post injection topical antibiotics should be avoided following Intravitreal injections of anti VEGF as it can increase microorganism resistance, virulence and add additional cost for the patients.