Mean Baseline Central Retinal Thickness Research Articles

Incidence of adverse events after loading phase of the brolucizumab therapy of neovascular AMD: Real-life evidence in the Czech Republic.

To evaluate the incidence of ocular adverse events after loading phase of the brolucizumab therapy in patients with neovascular age-related macular degeneration (nAMD) in real-life clinical practice - in treatment-naive patients and in patients after switching from another anti-VEGF agent. Another aim was to evaluate treatment outcomes in patients with adverse events. This is a multicentre, retrospective, observational study from 16 application centres in the Czech Republic. Patients diagnosed with nAMD were treated with brolucizumab in a fixed regimen of loading phase (3 injections administered at one-month intervals) and the mean follow-up period was 120 ± 10 days after the first injection. The incidence of adverse events and the development of best corrected visual acuity (BCVA) and central retinal thickness (CRT) in patients with complications were evaluated. A total of 1,098 eyes were followed up, of which 783 were treatment-naive and 315 eyes were after switching from another anti-VEGF agent. Adverse events were recorded in 42 eyes (3.83%), of which 30 eyes were treatment-naive (2.7%) and 12 eyes were post-switch (1.09%). The mean baseline BCVA ± SD was 56.7 ± 10.7 ETDRS chart letters in the group of patients with adverse events, 58.8 ± 10.1 letters in treatment-naive patients, and 51.4 ± 10.2 letters in patients after switch from another anti-VEGF agent. The mean baseline CRT ± SD was 432.2 ± 154.7 μm, being 435.8 ± 137.3 μm in treatment-naive patients and 424.5 ± 186.6 μm in patients after switch from another anti-VEGF agent. At the end of the follow-up, the mean BCVA ± SD was 53.4 ± 9.5 ETDRS charts letters in patients with adverse events, 55.6 ± 10 letters in treatment-naive patients, and 47.6 ± 10 letters in patients after switching from another anti-VEGF agent. The mean CRT ± SD at the end of the follow-up was 300.7 ± 115.7 μm in the total patient cohort, 285.2 ± 78.8 μm in treatment-naive patients and 334.5 ± 165.4 μm in patients after switching from another anti-VEGF agent. We observed the development of adverse events in the form of intraocular inflammation or vasculitis with subsequent decrease in BCVA in 3.83% of cases after loading phase of the brolucizumab therapy. The decrease in BCVA was reversible in most cases after initiation of anti-inflammatory steroid treatment. From a functional and morphological point of view, we did not demonstrate any statistically significant difference between the groups of treatment-naive patients and patients after switching from another anti-VEGF agent.

Assessment of Reinjection Numbers and Intervals for Diabetic Macular Edema Patients Who Received Dexamethasone Intravitreal Implants in Germany and Switzerland.

PurposeThe purpose was to assess the number and intervals of dexamethasone intravitreal implant (DEX) reinjections in a real-world setting for the treatment of diabetic macular edema (DME) and to determine the relationship with effectiveness and safety.Patients and MethodsData were abstracted from medical records of DME patients in Germany and Switzerland for this retrospective, multicenter, drug utilization study. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) changes 7−12 weeks post-injection(s) measured effectiveness. Adverse events (AEs) of special interest were reported.ResultsA total of 141 patients, 108 from Germany and 33 from Switzerland, were assessed. Mean (SD) reinjection interval was 5.7 (4.2) months. Mean baseline BCVA was 61.6 letters, and mean baseline CRT was 413.3 µm. The mean BCVA and CRT changes at 7−12 weeks after baseline, reinjection 1, 2, and 3 were +3.4, +3.7, +3.2, and −1.4 letters and −88.3, −81.6, −102.4, and −124.1 μm, respectively. The Spearman correlation between change in BCVA and CRT and DEX reinjection interval was r=0.03 (P=0.66) and r=0.07 (P=0.38), respectively. Only 18% of patients experienced at least 1 AE.ConclusionThere was no statistically significant correlation between drug effectiveness and reinjection intervals in either country. Although these results are preliminary, they indicate that DEX improves BCVA and CRT in real-world clinical practice.

Assessment of the efficacy of photodynamic therapy in patients with chronic central serous chorioretinopathy.

The aim of this prospective clinical study was to evaluate the anatomical and functional results of the treatment of 54 eyes with chronic form of central serous chorioretinopathy (CSC) using photodynamic therapy in areduced (half) verteporfin (HD-PDT) dosing regimen. Our prospective study included 54 eyes of 52 patients (40 males, 12 females) at an average age of 50.1 years (median 49.5, range 30-75 years) treated at the Ophthalmology Clinic of the First Faculty of Medicine and Military University Hospital in Prague from January 2012 to January 2018 for chronic form of CSC with aminimum disease duration of 3 months. In our study, we evaluated the improvement of the best corrected visual acuity (BCVA) and central retinal thickness (CRT) before treatment and at 1, 3, 6 and 12 months after HD-PDT. The mean baseline BCVA was 68.91 ± 10.5 ETDRS letters (median 71; range 35-85) and the mean baseline CRT was 385.6 ± 118.5 µm (median 367, 5 µm; range 245-1000 µm). At the end of the follow-up period, the average BCVA was 79 ± 11 ETDRS letters (median 82; range 38-93). The improvement in BCVA before and after treatment was statistically significant in all measurements (p < 0.0001). The mean CRT at the end of the follow-up period was 263.5 ± 52 µm (median 258.5 µm; range 162-404 µm). The decrease in CRT at all timepoints was statistically significant compared to baseline (p < 0.0001). In our set of patients, at the end of the follow-up period, the retinal finding was improved or stabilized in 50 eyes (92.6 %). In this study, we observed in 2 cases the development of secondary choroidal neovascularization (CNV). HD-PDT is along-term safe and effective method of treating chronic forms of CSC. However, despite areduced dose of verteporfin, complications may occur.

Ranibizumab in macular oedema secondary to branch retinal vein occlusion - 24 months of treatment.

To retrospectively evaluate the efficacy and safety of ranibizumab treatment for macular edema (ME) secondary to branch retina vein occlusion (BRVO) after 24 months. This study included 39 eyes of 39 patients with ME associated with BRVO treated at the Ophthalmology Department of Faculty Hospital in Hradec Kralove. The average age of included patiens was 69,3 years, the mean duration of symptoms before treament was 5,4 months, the mean baseline visual acuity (VA) was 54,6 ETDRS (Early Treatment Diabetic Retinopathy Study) letters, the mean baseline central retinal thickness (CRT) was 544,9µm. At 64,1% patients aretinal laserphotocoagulation was performed before intravitreal ranibizumab. After one year, the study was discontinued by 17 patiens, the remaining 22 patients were observed for 24 months. Initially, there were 3 doses of intravitreal ranibizumab administered in monthly intervals, further injections were applied according to PRN (pro re nata) regiment. Patients were examined at baseline and then at 3, 6, 9, 12 and 24 months from initiation of the treatment. In this study, the effect of ranibizumab on functional and morphological parameters of the affected eye was monitored, the safety of this treatment was also evaluated. During the follow-up, astatistically significant improvement in VA was achieved in every visit in comparison to baseline parameters, the mean VA gain at the 3 month visit was 12,1 ETDRS letters (p.

Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic

Purpose To present a cohort of treatment-naive patients with the neovascular form of age-related macular degeneration (nAMD) treated with aflibercept in a fixed regimen and evaluate the treatment response of three types of choroidal neovascular membrane (CNV)—occult (Type 1), classic (Type 2), and minimally classic (Type 4). Methods This was a multicentre, prospective, observational consecutive case series study. Patients diagnosed with three types of CNV of nAMD were treated in a fixed regimen (3 injections every 4 weeks, and then injections at 8 week intervals). The follow-up period was 48 weeks. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and spectral-domain optical coherence tomography (OCT). The measurements were taken at the baseline and then at 16, 32, and 48 weeks. Results The treatment-naive group was composed of 135 eyes of 135 patients in the study. 61 eyes had Type 1 lesions of CNV, 50 eyes had Type 2 lesions, and 24 eyes had Type 4 lesions. Mean baseline BCVA ± SD for Type 1 lesions was 56.1 ± 10.8 ETDRS letters, and then 62.2 ± 12.9 letters, 61.2 ± 13.7 letters, and 62.8 ± 15.1 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD for Type 1 lesions was 442.4 ± 194.9 μm, and then 302.5 ± 144.4 μm, 299.7 ± 128.5 μm, and 277.7 ± 106.5 μm at 16, 32, and 48 weeks, respectively. Mean baseline BCVA ± SD for Type 2 lesions was 55.6 ± 9.9 ETDRS letters, and then 62.5 ± 11.1 letters, 60.7 ± 13.0 letters, and 62.5 ± 14.2 letters at 16, 32, and 48 weeks, respectively. Mean baseline CRT ± SD. For Type 4 lesions mean baseline BCVA ± SD was 56.7 ± 9.0 ETDRS letters, and then 59.1 ± 10.6 letters, 59.5 ± 11.4 letters, and 59.2 ± 12.6 letters at 16, 32, and 48 weeks respectively. Mean baseline CRT ± SD for Type 4 lesions was 492.1 ± 187.0 μm, and then 333.3 ± 137.5 μm, 354.4 ± 175.0 μm, and 326.7 ± 122.4 μm at 16, 32, and 48 weeks respectively. All these changes were statistically significant (p < 0.005). Conclusions The primary outcome of our study is that the treatment with aflibercept in nAMD patients led to statistically significant improvement in BCVA and to a decrease in CRT throughout the follow-up period in both occult and classic types of CNV. The minimally classic type of CNV demonstrated a poorer functional and anatomical response to treatment.

Collateral vessels on optical coherence tomography angiography in eyes with branch retinal vein occlusion

AimsTo detect collateral vessels using optical coherence tomography angiography (OCTA) in eyes with branch retinal vein occlusion (BRVO) and to investigate the associations with visual outcomes and macular oedema.MethodsEyes with...

Central retinal thickness assessment in a real life setting after cataract surgery in diabetic patients

To assess in a real life setting the progression of central retinal thickness (CRT) during the first month after surgery in diabetic patients without previous diabetic macular edema (DME) and to identify potential risk factors for DME leading to increased postoperative follow-up. We conducted a prospective study of diabetic patients without history of DME who underwent uncomplicated cataract surgery. Best-corrected visual acuity (BCVA) and SD-OCT were performed 7 days and 1 month after surgery. We assumed absence of preoperative DME when there was no edema of SD-OCT at D7. Our primary endpoint was the central retinal thickness (CRT) variation between 7 days and 1 month after cataract surgery in patients without previous history of DME. We included 55 eyes of 42 patients. BCVA was 0.57±0.72 logMar (20/80) prior to surgery and increased significantly to 0.11±0.17 (20/25) at one month (P=0.001) post-surgery. The mean baseline CRT was 209±35μm and 229±69μm (P=0.06) one month after surgery. Four eyes (7.4%) developed macular edema at one month. We found no linear correlation between HbA1C and CRT. We found no link between a high level of HbA1C and postoperative increase in CRT. We found that cataract surgery in diabetic patients without previous DME has no negative impact on CRT, and visual outcomes are good. We suggest that in diabetic patients without complete visual recovery at 1-month post-cataract surgery, OCT examination should be performed in order to detect an early stage of DME.

Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes.

Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P < 0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P < 0.001) 12 months after one (P = 0.001), two (P = 0.041), and three (P < 0.001) implants but not four implants (P = 0.068). The mean baseline CRT decreased significantly (P < 0.001) from 463 to 254 microns after 12 months with one (P < 0.001), two (P = 0.002), and three (P = 0.001) implants but not with four implants (P = 0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.

Intravitreal anti‐VEGF treatment for refractory diabetic macular edema

PurposeTo compare anti‐VEGF monotherapy with combination treatment of anti‐VEGF injections plus macular laser (focal or modified grid) for refractory diabetic macular edema (DMO).MethodsWe included patients with DMO who had more than 6 anti‐VEGF injections and were examined in the Macula clinic. Our outcomes were change in BCVA, CRT and number of anti‐VEGF injections.ResultsWe included 22 patients (13 males and 9 females) with a mean follow up of 24 months. Mean age was 63.18 years (range: 47–77 years). 4 patients had Type 1 and 18 had Type II diabetes. 86.36% had hypertension and 68.18% hyperlipidaemia on treatment. 22.72% were pseudophakic, 45.45% had bilateral DMO and 45.45% had PRP laser. 70% of patients had Lucentis injections and 30% had Avastin injections. 70% were on anti‐VEGF monotherapy and 30% had combination therapy (macular laser plus anti‐VEGF injections). Mean baseline BCVA (in letters) was 27.24 and improved to 30.27 on last visit (+6 letters gain). Mean baseline Central Retinal Thickness (CRT) was 518.33 µm and decreased to 356.24 µm (−162.08 µm) on last visit. Mean number of injections was 8.88. Subgroup analysis showed that those who had anti‐VEGF monotherapy improved their BCVA during the follow up period to +7.6 letters and those on combination therapy improved to +5.82 letters. CRT decreased from baseline to last visit on both groups.ConclusionsBoth treatment groups improved their VA and CRT from baseline, however, anti‐VEGF monotherapy had better visual outcomes compared to combination treatment.

Ranibizumab 0.5 mg for Diabetic Macular Edema with Bimonthly Monitoring after a Phase of Initial Treatment: 18-Month, Multicenter, Phase IIIB RELIGHT Study

To evaluate ranibizumab 0.5 mg using bimonthly monitoring and individualized re-treatment after monthly follow-up for 6 months in patients with visual impairment due to diabetic macular edema (DME). A phase IIIb, 18-month, prospective, open-label, multicenter, single-arm study in the United Kingdom. Participants (N = 109) with visual impairment due to DME. Participants received 3 initial monthly ranibizumab 0.5 mg injections (day 0 to month 2), followed by individualized best-corrected visual acuity (BCVA) and optical coherence tomography-guided re-treatment with monthly (months 3-5) and subsequent bimonthly follow-up (months 6-18). Laser was allowed after month 6. Mean change in BCVA from baseline to month 12 (primary end point), mean change in BCVA and central retinal thickness (CRT) from baseline to month 18, gain of ≥10 and ≥15 letters, treatment exposure, and incidence of adverse events over 18 months. Of 109 participants, 100 (91.7%) and 99 (90.8%) completed the 12 and 18 months of the study, respectively. The mean age was 63.7 years, the mean duration of DME was 40 months, and 77.1% of the participants had received prior laser treatment (study eye). At baseline, mean BCVA was 62.9 letters, 20% of patients had a baseline BCVA of >73 letters, and mean baseline CRT was 418.1 μm, with 32% of patients having a baseline CRT <300 μm. The mean change in BCVA from baseline to month 6 was +6.6 letters (95% confidence interval [CI], 4.9-8.3), and after institution of bimonthly treatment the mean change in BCVA at month 12 was +4.8 letters (95% CI, 2.9-6.7; P < 0.001) and +6.5 letters (95% CI, 4.2-8.8) at month 18. The proportion of participants gaining ≥10 and ≥15 letters was 24.8% and 13.8% at month 12 and 34.9% and 19.3% at month 18, respectively. Participants received a mean of 6.8 and 8.5 injections over 12 and 18 months, respectively. No new ocular or nonocular safety findings were observed during the study. The BCVA gain achieved in the initial 6-month treatment period was maintained with an additional 12 months of bimonthly ranibizumab PRN treatment.

Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (P < 0.001), 0.60 ± 0.40 (P < 0.001), and 0.78 ± 0.39 (P = 0.07) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (P < 0.001), 0.99 ± 0.38 (P < 0.001), and 0.72 ± 0.37 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (P < 0.001), 0.64 ± 0.44 (P = 0.036), and 0.46 ± 0.49 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146 μm to 242 ± 119 μm, 277 ± 131 μm, and 402 ± 166 μm at 1, 3, and 6 months after IVT (P < 0.001 for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months.

DEXAMETHASONE INTRAVITREAL IMPLANT FOR TREATMENT OF UVEITIC PERSISTENT CYSTOID MACULAR EDEMA IN VITRECTOMIZED PATIENTS

To evaluate the safety and efficacy of Ozurdex (dexamethasone intravitreal implant) 0.7 mg in the treatment of uveitic macular edema in vitrectomized eyes. Data from 13 patients (17 eyes) with persistent uveitic cystoid macular edema and a history of pars plana vitrectomy in the study eyes that were treated with intravitreal injection of 0.7-mg dexamethasone implant were reviewed retrospectively. Main outcome measures were changes in central retinal thickness measured by optical coherence tomography and changes in best-corrected visual acuity. The median age of patients was 61 years (range, 19-81 years). The median duration of uveitic macular edema was 12 months (range, 2-72 months). The mean baseline central retinal thickness (95% confidence interval) was 461.6 μm (403.8-519.4), decreased to 277.2 μm (244.6-309.8) at 4 weeks (P < 0.01), remained low at 349.9 μm (281.8-418.0) at 3 months (P = 0.01), and then reached 394.1 μm (328.3-459.8) at 6 months (P = 0.14). After 3 months, there was a median improvement of 2 lines of best-corrected visual acuity, with 52.9% of eyes gaining 2 lines or more (P < 0.01). At 6 months, there were 5 eyes that maintained the 2 lines gain and none had lost >1 line from baseline (P = 0.03). In 8 eyes (47.1%), reinjection of the implant was performed at a mean of 6.5 months. Ocular hypertension (47.1%), hypotony (11.8%), anterior chamber displacement of the implant (5.9%), and glaucoma, which required filtration surgery (5.9%), were the most common adverse events. Mean follow-up was 9.6 months (range, 6-17 months). In this small case series of eyes with limited follow-up, treatment with dexamethasone intravitreal implant injection for uveitic macular edema in vitrectomized eyes was associated with favorable visual outcomes and had an acceptable safety profile.

The Predictive Value of OCT Characteristics for the Visual Outcome in Neovascular AMD

The intravitreal injection of an anti-VEGF compound is the current standard of care in neovascular AMD. The response to this therapy varies greatly. To date it was not possible to determine clear predictive factors in regard to therapy response, thus making it difficult when counselling patients regarding the probability for visual improvement. The aim of this study was to evaluate baseline OCT characteristics in regard to their predictive value on the outcome of visual acuity (VA) after 12 months. A retrospective analysis of 75 eyes with neovascular AMD treated with intravitreal anti-VEGF injections at the University Hospital of Zurich with a documented follow-up of at least 12 months. Measurement and comparison of the following OCT structures were undertaken: central retinal thickness (CRT), integrity of the IS/OS junction, and presence of intra- or subretinal fluid. VA at baseline and after 12 months was evaluated. OCT findings were compared between eyes that gained ≥ 5 letters ETDRS (group 1) and eyes that did not (group 2). 75 eyes with a mean baseline VA of 57.2 ± 15 letters and a mean baseline CRT of 430 ± 226 μm were analyzed. Although baseline VA did not differ statistically significantly, eyes in group 2 had a higher VA than eyes in group 1 (60.2 ± 16.2 vs. 54.9 ± 13.6, p = 0.123). In group 1 the change of VA after 12 months was 12.6 ± 8.0 letters while it was -5.0 ± 7.8 letters in group 2. No statistically significant differences between the two groups with respect to the analyzed OCT parameters were found. None of the analyzed OCT factors had a predictive value regarding the VA outcome at month 12. Our study was not able to find baseline OCT parameters that could predict the course of VA after 12 months. However, eyes with a thicker central retinal thickness at presentation showed a greater reduction in CRT during the analyzed period. This was associated with a more favourable course in VA. Perhaps this might be due to a less pronounced initial morphological retinal damage.

Bevacizumab injection in patients with age-related macular degeneration associated with poor initial visual acuity.

Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity. Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection. Results. Mean followup was 14.1 months ± 7.1 (range: 5 to 24 months). Mean logMAR vision at baseline was 1.38 logMAR ± 0.33, at 6 months was 1.14 logMAR ± 0.37 (P = 0.001) and at 12 months was 1.22 logMar ± 0.33 (P = 0.004). Mean baseline central retinal thickness was 431 μm ± 159.7 at 6 months was 293.43 μm ± 122.79 (P = 10−4) and at 12 months was 293.1 μm ± 130 (P = 0.004). Visual acuity improved in both patients with or without prior PDT treatment. Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.

Intravitreal bevacizumab (AVASTIN®) in the treatment of diabetic macular oedema

Abstract Purpose To report visual acuity and anatomic response to intravitreal bevacizumab(IVB) injection in patients with persistent diabetic macular oedma(DMO). Methods Clinic notes of 19 patients (20eyes)were retrospectively evaluated. VA in ETDRS, central retinal thickness (CRT) and number of IVB (1.25mg/0.05mi)injections required was recorded. All patients underwent at least one FFA prior to IVB therapy. Re‐treatment was PRN based on persistent or increase in fluid with drop of VA.Previous treatments included triamcinolone (IVTA),grid (micropulse and green) lasers.Follow up was every 6weeks. Results The mean age was 69.5±6.9 (range 59‐81) years. All eyes had previous lasers. Seven eyes had both laser and IVTA. Mean number of bevacizuamab injection was 1.15. Three eyes received 2nd injection at mean of 13.3weeks (range 4‐24) and 1 eye a 3rd injection at 9weeks. The average interval between the grid lasers and avastin therapy was 18.9weeks (SD=10.35). Mean follow up was 6.45±1.1 (6‐9) months. The mean baseline VA was 42.51±16.24 and mean baseline CRT was 471±95.23. The mean change in vision at 1st 3rd and 6th month was +10.8, +11.8 and +13.2(p=0.0867) The mean reduction in CRT from baseline was ‐101.36µm,‐167.7µm and‐149.25µm at month 1, 3 and 6 respectively. (p= 0.00912). Three patients completed 9months follow up with a mean change in VA of +10.83 and CRT of‐105µm. Twenty‐ five percent gained &gt;15letters, 75% maintained stable vision and none lost more than 15 letters. No complications recorded. Conclusion Intravitreal bevacizumab 1.25mg was followed by improvement of vision and a significant reduction in persistent DMO. Further, larger studies are needed to evaluate the long term efficacy and safety of IVB on persistent diabetic macular oedema.

Intravitreal Bevacizumab for the Treatment of Refractory Diabetic Macular Edema

To report the effect of intravitreal bevacizumab on visual acuity and central retinal thickness (CRT) in refractory diabetic macular edema. Records of 60 eyes of 54 consecutive patients who underwent intravitreal bevacizumab therapy for refractory diabetic macular edema were reviewed. All eyes received intravitreal bevacizumab 1.25 mg/0.05 mL, and 36 eyes underwent pretreatment and post-treatment optical coherence tomography. Mean follow-up was 7.4 months. Pretreatment mean visual acuity plus or minus standard deviation was 0.71 +/- 0.28 logarithm of the minimum angle of resolution (LogMAR) Snellen letters. At final follow-up, mean visual acuity had improved to 0.66 +/- 0.30 LogMAR (P = .0543). Mean baseline CRT was 440 +/- 106 microm, and follow-up mean CRT was 386 +/- 129 microm (P = .008). Vitrectomized eyes had worse visual acuity and CRT outcomes (P = .002 and P = .028, respectively) compared with nonvitrectomized eyes. Intravitreal bevacizumab may provide a functional and anatomic benefit in eyes with persistent diabetic macular edema despite previous treatments.

Role of Avastin in management of central serous chorioretinopathy

Purpose To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC). Design Prospective interventional series non-comparative study. Setting Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt. Methods The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6 months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25 mg (0.05 mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1–3 injections) 6–8 weeks intervals and follow up for 6 months (range 5–7 months). All finding at baseline and each follow up visit were reported and compared. Results The mean age of all patients was 40.3 years ± 6.5 (range 25–50 years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change ( P < 0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change ( P < 0.002). The mean baseline CRT for all patients was 486 ± 86 μm (range, 386–580), decreased to 316 ± 56 μm (range, 276–368) after 1 months with statistically significance difference change ( P < 0.02) and to 272 ± 52 μm (range 220–338) at last follow up with statistically significance difference change from the baseline ( P < 0.001). Conclusions Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.

Early Avastin management in acute retinal vein occlusion

Purpose To evaluate the safety, functional and anatomical effects of intravitreal Avastin (bevacizumab) in treatment of recent retinal venous occlusion. Design Prospective interventional series non-comparative study. Setting Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt. Methods The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3 months duration 12 eyes (40%) of patients with central retinal vein occlusion (CRVO) and 18 eyes (60%) with branch retinal vein occlusion (BRVO) were injected with intravitreal bevacizumab 1.25 mg (0.05 ml) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25 mg/ml as a primary treatment. The mean number of injections was 2.7 (range, 1–6 injections) 6–8 weeks intervals and follow-up for 12 months (range, 9–13 months). Patients underwent visual acuity testing (VA) as functional assessment. Anatomically, optical coherence tomography (OCT) is used for measurement of central retinal thickness (CRT) to detect macular edema (ME), fundus photography and fluorescein angiography (FA) to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported. Results The mean age of all patients was 65.3 years ± 8.5 (range, 55–82 years), 20 males and 10 females patients. The mean baseline VA was 20/240 (log MAR 1.08 ± 0.52) and improved to 20/60 (log MAR 0.48 ± 0.32) with statistically significance difference change ( P < 0.001). The mean baseline CRT was 455 μm ± 126 (range, 386–510), decreased to 356 μm ± 118 (range, 296–416) after 1 month with statistically significance difference change ( P < 0.02) and to 402 μm ± 170 (range, 338–468) after 6 months ( P < 0.067) and to 250 μm ± 48 (range, 200–298) at last follow-up with statistically significance difference change from the baseline ( P < 0.001). There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1 month of injection. Neither systemic nor intraocular adverse events were reported. Conclusions Intravitreal Avastin (IVA) is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion.

Intravitreal Avastin for macular oedema secondary to retinal vein occlusion: a prospective study

Objective:To evaluate efficacy and safety of intravitreal bevacizumab (Avastin) in eyes with macular oedema secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO).Methods:Twenty-eight consecutive patients (28...

Intravitreal triamcinolone acetonide for the management of papillophlebitis and associated macular edema

To investigate the efficacy of intravitreal injection of triamcinolone acetonide in the management of papillophlebitis and associated cystoid macular edema. This study was a retrospective medical records review of four eyes of four patients (three males and one female) who had approximately 2-4 months history of papillophlebitis and associated persistent cystoid macular edema. These patients were treated with a single intravitreal injection of 4 mg triamcinolone acetonide. Mean follow-up time was 15 +/- 4 months. The outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness by optical coherence tomography (OCT). The BCVA ranged from 20/100 to 20/60 pre-operation. The mean gain in BCVA was 7 +/- 1 Snellen lines. All eyes had BCVA of 20/20 at the last visit. The mean baseline central retinal thickness as measured by OCT was 529 +/- 53 microm. The mean central retinal thickness by OCT was 235 +/- 15 microm at 1-week follow-up examination. At the last visit the mean central retinal thickness by OCT was 161 +/- 7 microm. One patient experienced an increase in IOP after the first injection and another patient had IOP elevation after the second injection. Both were well controlled with single topical anti-glaucoma medication. Intravitreal injection of triamcinolone acetonide appears to be an effective treatment for patients with papillophlebitis and associated cystoid macular edema.