Single Intravitreal Injection Of Bevacizumab Research Articles

An Adolescent Case of Unilateral Papillophlebitis Treated with Intravitreal Bevacizumab

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

Changes in aqueous concentrations of various cytokines after intravitreal bevacizumab injection for chronic central serous chorioretinopathy.

This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). In a prospective interventional trial, 12 eyes of 12 patients with chronic CSC and 6 eyes of 6 patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. After injection, the foveal thickness decreased significantly from 328 (210-477) to 283 (168-356) (p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (1.5-8.3) to 4.7 pg ⁄ mL (2.2-11.6) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (17.0-53.3) to 15.2 pg/mL (7.7-21.5) (p < 0.01). No significant changes in IL-6, IP-10, MCP-1, and PDGF-AA levels were noted 4 weeks after injection (p = 0.455, p = 0.055, p = 0.076, and p = 0.339, respectively). In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.

Revascularization of immature retinas with retinopathy of prematurity using combination therapy of deferred laser treatment after a single intravitreal bevacizumab injection

Background: This study aimed to observe the extent of retinal vascularization in patients with retinopathy of prematurity (ROP) who underwent deferred laser treatment (LT) after a single intravitreal bevacizumab injection (IVB).Methods: This study retrospectively evaluated 40 consecutive eyes in 21 infants who received a single IVB or LT. Deferred LT was performed in cases of ROP recurrence after a single IVB. To assess the amount of retinal vascularization between the initial IVB and deferred LT, the cases were divided into three groups based on treatment: single IVB, deferred LT after a single IVB, and prompt LT. The growth and associated complications were compared between groups.Results: There were 12, 16, and 12 eyes in the single IVB, deferred LT, and prompt LT groups, respectively. Deferred LT was performed at an average of 7.9 weeks after a single IVB. In the single IVB group, retinal vascularization proceeded to zone III, whereas the prompt LT group did not show any growth of vascularization beyond the laser scars. In the deferred LT group, during the window period before LT, retinal vascularization progressed from zone I to zone II posterior and from zone II posterior to zone II anterior, respectively, without further ROP recurrence. Conclusions: Retinal vascularization progressed during the deferred window period, thereby reducing the area of the retina ablated by LT. A single IVB followed by deferred LT can be an alternative treatment option to prevent ablation of zone I or multiple IVBs.

Comparative Study between Targeted Retinal Photo coagulation With and Without Single Intravitreal Bevacizumab Injection Versus Conventional Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Treatment

Comparative Study between Targeted Retinal Photo coagulation With and Without Single Intravitreal Bevacizumab Injection Versus Conventional Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Treatment

Short-term outcomes in patients with center-involving diabetic macular edema after a single dose of intravitreal bevacizumab

BackgroundA significant portion of diabetic macular edema (DME) is refractory to anti-vascular endothelial growth factor (anti-VEGF) agents. This study investigates morphological and functional outcomes to a single intravitreal bevacizumab (IVB) injection in patients with center-involving DME (ciDME) at 4–6 weeks and compares treatment responders and non-responders based on spectral domain optical coherence tomography (SD-OCT) features.MethodsIRB approved observational, retrospective chart review of patients with ciDME, identified by ICD-10 code, who received IVB and underwent baseline and 4–6 weeks follow-up SD-OCT imaging between January 1, 2016 and January 19, 2021. Patients who had received previous treatment with anti-VEGF or intraocular steroids within 1 year were excluded. Variables included best-corrected visual acuity (BCVA), central subfield thickness (CST) and total macular volume (TMV). Eyes were classified as responders if CST reduction was greater than 10%. OCT scans were graded qualitatively by two masked graders using Imagivault software. Paired Student’s t-tests, Wilcoxon signed rank tests and Chi-Square tests were used for analysis.ResultsA total of 334 prospective subjects were identified, and after applying exclusion criteria 52 eyes from 46 patients (mean age 64.22 ± 8.12 years, 58.7% male) were included. Mean BCVA did not significantly change with treatment, 63.9 ETDRS letters (~ 20/50) at baseline and 65.9 ETDRS letters (~ 20/50) post-treatment (p = 0.07). Mean CST decreased from 466 ± 123 μm at baseline to 402 ± 86 μm post-treatment (p < 0.001). 22 (42.3%) of eyes were categorized as responders and 30 (57.7%) as non-responders. Average change in CST from baseline in responders was -164 μm (p < 0.001) and + 9 μm in non-responders (p = 0.47). Vitreomacular adhesion (VMA) was more prevalent in non-responders (28.7% vs. 4.8%, p = 0.03). In addition, cyst location in the inner nuclear layer (INL) was present more frequently in responders (95.5% vs. 73.3%, p = 0.037) as was subretinal fluid (45.5% vs. 13.3%, p = 0.01).ConclusionThe short-term response to a single IVB was sub-optimal with structural but no functional improvements. Greater baseline CST, presence of INL cysts and subretinal fluid may represent factors indicative of a better treatment response.

Aggressive Posterior Retinopathy of Prematurity: Long-Term Outcomes Following Intravitreal Bevacizumab.

PurposeThe purpose of this study is to review the neonatal and early childhood course of children who were treated with intravitreal bevacizumab for APROP and identify any long term limitations these children face years after treatment.MethodsThis retrospective consecutive case series reviewed both ophthalmologic and pediatric medical records to determine ocular and neurologic function following treatment with a single injection of intravitreal bevacizumab (IVB) for APROP. Patient records were reviewed to identify the gestational age, average birth weight, gender, post-menstrual age (PMA) at the time of injection, regression status, rescue therapy events, final visual acuity, final refraction, ophthalmologic diagnoses and complications, neurologic diagnoses, and duration of follow up.ResultsThe study included 43 eyes from 13 male and 9 female children. The average gestational age was 24 weeks and average birth weight was 625.2 grams. The average follow-up was 4.08 years (range: 1.85–7.36 years). The average PMA at time of bevacizumab injection was 35.59 weeks. Thirty-five eyes eventually received laser photocoagulation at an average PMA of 53.17 weeks. All eyes in this study demonstrated regression without progression to retinal detachment. At last follow up, 67% (29/43) of eyes were able to discern letters or shapes, with an average visual acuity of 20/37. 16 (72%) children were diagnosed with perinatal neurological disorders. 59% (n = 13) developed chronic neurological impairment, 77% (n = 10) of whom developed neurodevelopmental delay. Several infants were diagnosed with endocrine disease or genetic syndromes.ConclusionsExtreme prematurity is associated with significant morbidity. Nearly all infants (92%) who developed chronic neurologic disease were diagnosed with neurologic disease during the perinatal period. Intravitreal bevacizumab, often with adjuvant photocoagulation, led to regression without detachment in 100% of eyes, with most verbal children retaining functional vision.

Efficacy Of Macular Photocoagulation When Given In The Early Or Late Period After Single Intravitreal Bevacizumab Injection In Terms Of Central Foveal Thickness Change And Visual Acuity Gain

AIM: To find out the efficacy of macular photocoagulation when given in the early or late period after single intravitreal bevacizumab injection in terms of central foveal thickness change and visual acuity gain.METHODS:40 patient eyes were studied and they were divided into groups based on sex, age, hba1c levels, severity of disease and treatment received over the period of 6months.RESULT: patients receiving deferred macular photocoagulation after a single intravitreal injection of bevacizumab had better outcomes regarding reduction of central foveal thickness and improvement in visual acuity at the end of 6-month observation period compared to those patients receiving prompt macular photocoagulation.

Macular microvascular changes after intravitreal bevacizumab injection in diabetic macular edema

ObjectiveTo evaluate the changes in retinal capillary plexus and the choriocapillaris after a single intravitreal injection of bevacizumab in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). DesignProspective interventional case series. ParticipantsPatients having diabetes with centre-involving diabetic macular edema. MethodsIn this prospective interventional case series, eyes with centre-involving diabetic macular edema were enrolled. Vascular density (VD), vascular diameter index (VDI), vascular length density (VLD), foveal avascular zone (FAZ) area, and foveal density (FD)-300 were measured using en face OCTA images before and 1 month after administration of intravitreal bevacizumab. VD and VDI measurements were performed in the superficial capillary plexus (SCP) and deep retinal capillary plexus (DCP) and in the choriocapillaris. Additionally, capillary nonperfusion area (CNPA) was detected automatically based on vessel distance map in 4 concentric rings around the foveal centre. The segmentation error was manually corrected, and the measurements were performed by 2 expert graders. ResultsTwenty-three eyes of 19 patients with a mean age of 62.76 ± 6.88 years were included. There were no significant changes in the FAZ area, FD-300, or in the VD of the foveal and parafoveal SCP and DCP. Also, VLD and VDI of the SCP and DCP remained unchanged. The change in the CNPA was not statistically significant. The VD of choriocapillaris increased significantly after injections (p = 0.005). ConclusionsFAZ area and VD of the retinal capillary plexus remained stable in the short-term period after intravitreal bevacizumab. In addition, the choriocapillaris blood flow improved after bevacizumab injection.

Effect of a Single Intravitreal Bevacizumab Injection on Proteinuria in Patients With Diabetes.

PurposeProteinuria is the second most common complication after hypertension after systemic administration of bevacizumab. Therefore we aimed to analyze the effect of intravitreal bevacizumab (IVB) injection on proteinuria in patients with diabetes.MethodsPatients scheduled to receive IVB injection from May 1, 2018, to December 31, 2018, were prospectively enrolled. In total, 53 patients with diabetes (26 with nonproliferative diabetic retinopathy and 27 with proliferative diabetic retinopathy) and 37 patients without diabetes were included. Urine tests were performed within 1 month of and 7 ± 1 days after IVB injection. Urinary protein, creatinine, and albumin concentrations were quantitatively measured, and urinary protein-to-creatinine ratio and urinary albumin-to-creatinine ratio (UACR) were calculated from these data before and after IVB injection.ResultsThe mean urinary microalbumin concentrations and urinary protein-to-creatinine ratio were significantly higher in patients with diabetes, both before and after IVB injection. There were no differences between patients with nonproliferative diabetic retinopathy and proliferative diabetic retinopathy. About 80% of patients with diabetes showed improved albuminuria or at least no harmful effect in terms of albuminuria. Patients with deteriorated baseline UACR showed more residual increase in UACR after IVB injection (P < 0.05 in all groups).ConclusionsClose monitoring of renal function after IVB might be needed in patients with diabetes according to the severity of nephropathy.Translational RelevanceOur results may provide information regarding the renal function of IVB-treated patients with diabetes.

Comparison of outcomes of four different treatment modalities for diabetic vitreous haemorrhage

We compared outcomes of four different management modalities for diabetic VH. Patients with diabetic VH were identified in this retrospective study undertaken at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Eyes were grouped based on the treatment received: control (observation only), intravitreal bevacizumab (IVB) injection(s), pars plana vitrectomy (PPV), and preoperative single IVB injection before PPV. Best-corrected visual acuity (BCVA) and status of VH were noted at baseline and the last follow up (Minimum: 6 months, maximum: 29 months). The proportion of eyes with Snellen BCVA improvement by two lines or more and VH clearance at the last follow up were compared between groups. The four groups – Control, IVB, PPV, and IVB-before-PPV had 23, 29, 17, and 20 eyes, respectively. The proportion of eyes gaining ≥2 lines was substantially higher in the IVB-before-PPV and PPV groups (90% and 77%, respectively) compared with IVB and observation groups (41% and 22%, respectively). Surgical treatment was associated with a 2.38 times higher likelihood of gaining ≥2 lines than the non-surgical one (incidence ratio: 2.38, 95% CI 1.19, 4.78 P = 0.015) after adjusting for age, hyperglycemia and BCVA at presentation. Less invasive treatment such as IVB injections did not result in the same amount of improvement in vision as did PPV. Prospective randomized studies are needed to better define the role of IVB injections in the management of diabetic VH.

Choroidal Neovascularization Associated with Morning Glory Syndrome: A Case Report

Morning glory syndrome (MGS) is a congenital optic disc anomaly caused by abnormal closure of the embryonic fissure. Retinal detachment is commonly associated with MGS, though the association of choroidal neovascularization (CNV) with MGS is rare. Herein, we report a case of CNV associated with MGS, which was successfully treated with a single intravitreal injection of bevacizumab. A 32-year-old Japanese woman consulted at our clinic for blurred vision in her left eye for five days. Her best-corrected decimal visual acuity (BCVA) was 1.5 (S-1.0) OS. The fundus examination revealed subretinal hemorrhage associated with MGS in the temporal margin of the optic disc. As she was pregnant, we planned to continue follow-up without further invasive testing and treatment; however, her visit to the hospital was interrupted. Ten months later, she returned with complaints of poor vision and central scotoma in her left eye for six months. The BCVA was 0.5 (S-1.0/C-1.0/45°) OS. The fundus examination showed that subretinal hemorrhage increased, and the subretinal fluid extended below the fovea. Multimodal imaging revealed type 2 CNV on the temporal and nasal disc margins. After she received an intravitreal injection of bevacizumab (1.25 mg), rapid absorption of subretinal fluid and regression of CNV were observed. The BCVA improved to 1.5 (S-0.5/C-0.75/35°) OS. No recurrence of CNV was observed for 26 months after the injection. During the follow-up of MGS cases, we should pay attention, not only to retinal detachment, but also to the occurrence of CNV around the disc margins.

TIME COURSE OF CHANGES IN OPTIC DISK NEOVASCULARIZATION AFTER A SINGLE INTRAVITREAL BEVACIZUMAB INJECTION.

To evaluate the longitudinal changes in optic disk neovascularization (NVD) after intravitreal bevacizumab injection using optical coherence tomography angiography. In this prospective, interventional, case series, eyes with NVD secondary to diabetic retinopathy were enrolled. En face optical coherence tomography angiographic images were obtained from the optic disks before and 3 hours, 6 hours, 24 hours, 7 days, and 30 days after intravitreal bevacizumab injection. The size and flow area of the neovascularization were measured by two graders. Eleven eyes of 9 patients with a mean age of 52.11 ± 9.48 years were included. The reduction in the NVD size and flow area was statistically significant at 24 hours, 7 days, and 30 days after injections compared with the baseline measurements (all P < 0.05). The decremental regression in the NVD size and flow area continued during the study course. The changes were not statistically significant in 3-hour and 6-hour measurements (all P > 0.05). In this study, statistically significant regression in the NVD size and flow area was observed as early as 24 hours after a single intravitreal bevacizumab injection, with a continued decreasing trend for at least a 1-month period.

Aggressive Posterior Retinopathy of Prematurity Treated with Intravitreal Bevacizumab: Late Period Fluorescein Angiographic Findings.

To evaluate vascularization end limit of the peripheral retina and describe vascular development patterns of patients at the late period with aggressive posterior retinopathy of prematurity (APROP) who were treated with a single intravitreal injection of bevacizumab. All patients were examined with RetCam III and fluorescein angiography (FA) within 90-100 gestational week. The vascularization end limit according to the zones and vascular structural abnormalities were noted. A total of 116 eyes of 58 patients were included. The mean gestational age and birth weight were 28.31 ± 2.5 (23-33)weeks and 1156.29 ± 386.38 (360-2300)g, respectively. The mean age at the time of FA was 95.09 ± 3.8 (90-100)weeks. According to the vascular termini, four eyes (3.4%) were in zone II posterior, 30 eyes (25.8%) were in zone II anterior, 22 eyes (18.9%) were in zone III with a distance of > 2 disc diameter (DD) from ora serrata, and 60 eyes (51.7%) were in zone III with a distance of < 2 DD from temporal ora serrata. Abnormal vascular findings were detected in 86.2% of patients (100/116 eyes) including circumferential vessels (43.1%), abnormal vascular branching (25.9%), closely packed vascular shunts (6.8%), and vascular leakage (10.3%). FA gives us quantitative data for treatment decision at late period of APROP patients treated with bevacizumab. Fluorescein leakage and persistent avascular areas still detected at FA at 90-100 gestational weeks increase the risk for late complications. FA can detect the abnormalities that can not be detected via indirect ophthalmoscope and be useful for follow-up and further treatments of APROP.

FLORID NEOVASCULARIZATION OF THE RETINA IN A DIABETIC PATIENT UNDERGOING INDUCTION AND CONSOLIDATION THERAPY FOR ACUTE PROMYELOCYTIC LEUKEMIA

To report on a 39-year-old gentleman with a background of Type 2 diabetes mellitus who was diagnosed with acute promyelocytic leukemia (APL), which was treated by all-trans retinoic acid (ATRA), and subsequently developed bilateral neovascularization of the disk (NVD). Ophthalmic examination and investigation including fundus photography and fluorescein angiography. Three months after commencement of ATRA therapy, the patient was found to have florid bilateral NVD with adjacent preretinal and intraretinal hemorrhages. Fundus fluorescein angiography was undertaken and NVD was confirmed in both eyes, which was significantly greater than expected for the extent of disease secondary to diabetic retinopathy. As a result of the fluorescein angiography findings, we believe ATRA-mediated upregulation of vascular endothelial growth factor may be the etiology of the NVD. Literature review shows some in vitro studies, which describe ATRA-induced upregulation of vascular endothelial growth factor in ocular tissues. The patient was managed successfully by cessation of ATRA and a single intravitreal injection of bevacizumab in each eye. Acute promyelocytic leukemia treated with ATRA may result in upregulation of vascular endothelial growth factor in retinal tissues. Subsequent development of NVD may occur; however, this resolves well by cessation of ATRA and intravitreal injection of bevacizumab. We recommend that all patients undergoing treatment with ATRA for acute promyelocytic leukemia be monitored by an ophthalmologist.

Comparison of intravitreal bevacizumab injection and laser photocoagulation for type 1 zone II retinopathy of prematurity

PurposeTo compare the efficacy of intravitreal bevacizumab (IVB) injection with conventional laser photocoagulation in eyes with type 1 zone II retinopathy of prematurity (ROP). MethodsPreterm infants with type 1 ROP in zone II (stage 2 or 3 ROP with plus disease) were randomly assigned to intravitreal injection of 0.625 mg/0.025 ml bevacizumab (Group 1) or laser photocoagulation (Group 2). Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Also, spherical and cylindrical refractive errors were compared at 90 weeks postmenstrual age (PMA). ResultsA total of 116 preterm infants (232 eyes) were treated and completed the follow-up period. IVB injection was done in 154 eyes (77 cases), and laser photocoagulation was done in 78 eyes (39 cases). ROP regressed after single IVB injection in 149 eyes (96.8%) and in 5 eyes (3.2%) after the second injection. Cataract developed in one eye (0.63%) after IVB injection. ROP regressed in 94.7% of treated eyes (76 eyes) in the laser photocoagulation group; however, retinal fold and traction developed in 2 eyes. Spherical and also cylindrical refractive errors had no significant difference. ConclusionsBoth IVB injection and laser photocoagulation are effective methods for the treatment of type 1 zone II ROP. However, re-treatment requirement may be higher in the IVB injection group. IVB re-injection is an effective option for re-treatment in persistent cases.

EFFECTS OF INTRAVITREAL RANIBIZUMAB AND BEVACIZUMAB ON THE RETINAL VESSEL SIZE IN DIABETIC MACULAR EDEMA.

The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema. In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. The study groups were composed of the injected eyes, whereas the noninjected fellow eyes served as the control groups. The patients underwent complete ophthalmic examinations, including optical coherence tomography and fundus fluorescein angiography, and the primary outcome measures included the central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio. In the RAN study group (n = 32), the preinjection mean central retinal artery equivalent (175.42 μm) decreased to 169.01 μm after 1 week, and to 167.47 μm after 1 month (P < 0.001), whereas the baseline central retinal vein equivalent (235.29 μm) decreased initially to 219.90 μm after 1 week, and to 218.36 μm after 1 month (P < 0.001). In the BEV study group (n = 30), the preinjection central retinal artery equivalent (150.21 μm) decreased to 146.25 μm after 1 week, and to 145.89 μm after 1 month (P < 0.001); whereas the baseline central retinal vein equivalent (211.87 μm) decreased initially to 204.59 μm after 1 week and was 205.24 μm after 1 month (P < 0.001). The preinjection artery-to-vein ratio values changed significantly (P = 0.001) after 1 week and after 1 month in the RAN group, but no significant alteration in the artery-to-vein ratio was observed in the BEV group (P = 0.433). In both the RAN (n = 32) and BEV (n = 30) control groups, none of the 3 parameters changed throughout the study period, when compared with the baseline. The results of this study showed that both RAN and BEV injections significantly constricted the retinal blood vessel diameters.

Bevacizumab as an adjunct to vitrectomy for diabetic retinopathy: A retrospective study

Purpose: The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on the visual and anatomical outcome of patients undergoing 23-gauge pars plana vitrectomy (23G PPV) for proliferative diabetic retinopathy (PDR). Materials and Methods: Medical record from patients undergoing vitrectomy for PDR were retrospectively analyzed for the last 3 years. IVB has been a routine procedure for patients fulfilling eligibility criteria for the past 3 years. Patients who did not receive IVB preoperatively were assigned as control group (Group A). Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to Group B. Medical record of 100 patients who had completed 12-month follow-up were included in each group. Results: The primary outcome measure was visual outcome which was better in Group B as compared to Group A, anatomical outcome observed was 65% patients in Group A and 85% patients in Group B. The secondary outcomes were intraoperative hemorrhage and postoperative vitreous hemorrhage (VH). Intraoperative hemorrhage was seen in 40% patients in Group A and 20% patients in Group B, whereas postoperative VH was seen in 45% patients in Group A and 15% patients in Group B. Conclusion: Preoperative use of bevacizumab achieves excellent anatomical and functional success in majority of patients undergoing PPV for PDR and significantly reduced occurrence of postoperative VH. The results are encouraging when combined with transconjunctival 23 GPPV.

Serous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy: a case report

BackgroundProliferative diabetic retinopathy is a major cause of visual impairment in working-age adults worldwide. Panretinal photocoagulation is a cornerstone in its management; however, it may include a range of side effects and complications, one of these being serous retinal detachment. To the best of our knowledge, this is the first report of the use of intravitreal injection of bevacizumab for serous retinal detachment after panretinal photocoagulation.Case presentationA 24-year-old Saudi man with poorly controlled type 1 diabetes presented with bilateral progressive proliferative retinopathy in spite of several sessions of panretinal photocoagulation. After one additional such session, he developed bilateral serous retinal detachment and vision loss, which was managed with a single bilateral intravitreal bevacizumab injection. The serous retinal detachment subsided with partial recovery of vision.ConclusionsSerous retinal detachment after panretinal photocoagulation for proliferative diabetic retinopathy is a rare complication nowadays. In this case, it seems that excessive photocoagulation exceeded the energy-absorbing capacity of the retinal pigment epithelium, leading to a disruption of the blood–retinal barrier. A single injection of bilateral intravitreal bevacizumab was sufficient to control the serous retinal detachment. This effect may have been due to a reduction of vascular leakage resulting from the mechanism of action of this drug. No complications were noted from the injection. Caution should be exerted when attempting bilateral panretinal photocoagulation.

Visual and Anatomical Outcomes after Single Injection of Intravitreal Bevacizumab (Avastin) in Patients with Diabetic Macular Edema

Visual and Anatomical Outcomes after Single Injection of Intravitreal Bevacizumab (Avastin) in Patients with Diabetic Macular Edema

Aqueous vascular endothelial growth factor and clinical outcomes correlation after single intravitreal injection of bevacizumab in patients with neovascular age-related macular degeneration

Purpose To evaluate the concentration of vascular endothelial growth factor (VEGF) in aqueous humor after a single intravitreal injection of bevacizumab (IVB) in eyes with neovascular age-related macular degeneration (AMD).MethodsIn this prospective interventional case series study, 24 eyes of 24 patients with types 1 and 2 choroidal neovascularization secondary to neovascular AMD were treated with a single intravitreal injection of bevacizumab. Aqueous humor samples were obtained before the intravitreal injection and at one week, one month, and three months follow-up periods. Best-corrected visual acuity (BCVA) and three spectral-domain optical coherence tomography parameters (central retinal thickness, macular volume and macular area) were also analyzed and correlated with VEGF expression at the baseline and each follow-up period.ResultsAll of the ninety-six aqueous humor study taps were well tolerated by the study patients without adverse events. Increased VEGF levels (mean ± SD = 179.7 ± 88.3 pg/mL) were observed in the aqueous humor of all study patients before the intravitreal injection of bevacizumab. At all follow-up periods, compared to baseline, levels of VEGF significantly reduced (P < 0.0001), and BCVA significantly improved (P < 0.005). The lowest VEGF expression was observed at 1 week, and the greatest BCVA improvement occurred 1 month after treatment. At 1 month, central retinal thickness (CRT), macular volume (MV), and macular area (MA) significantly reduced compared to baseline (P < 0.0001, P = 0.0005, P = 0.007, P = 0.009, respectively). At 1 week and 3 months, although without statistical significance (P > 0.005), CRT, MV and MA also reduced in comparison to baseline.ConclusionsSingle intravitreal bevacizumab injection in eyes with neovascular AMD resulted in a substantial decrease of aqueous VEGF levels 1 week after treatment with the greatest improvement of clinical outcomes occurring at 1 month follow-up.