Intravitreal bevacizumab treatment for retinal neovascularization and vitreous hemorrhage in proliferative diabetic retinopathy
Ashraf M El-Batarny, Ashraf M El-Batarny
Abstract
Purpose: To report the short term anatomical and visual acuity response after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy.
Methods: Ten eyes having proliferative diabetic retinopathy were treated with at least one intravitreal injection of bevacizumab, 1.25 mg in 0.05 mL. Patients underwent complete ophthalmologic evaluation at baseline and follow up visits including Snellen's best corrected visual acuity (BCVA), fundus biomicroscopy and fluorescein angiography. Vitreous hemorrhage precluding laser treatment was present in 6 eyes.
Results: Follow up ranged between 3 and 6 months (mean 4.2 +/- 1.23 months). Improvement of vision was observed after one week with BCVA improved to 0.47 +/- 0.26 compared with baseline BCVA of 0.365 +/- 0.26 (P < 0.05). At last follow up, BCVA was 0.65 +/- 0.33. Seven eyes had better visual acuity. Vitreous hemorrhage cleared completely in 4 eyes while 2 eyes had residual vitreous hemorrhage. Regression of retinal neovascularization was complete in 7 eyes, incomplete in 3 eyes. Regression was observed as early as 2 weeks after first injection. Reperfusion after regression was observed in 2 eyes. Patients received a mean of 1.7 +/- 0.67 injections per eye. No complications were noted in all eyes. Pancryopexy was done in 1 eye and additional laser was done in 2 eyes.
Conclusion: Intravitreal bevacizumab was safe and effective in treatment of proliferative diabetic retinopathy. It can induce effective regression of retinal neovascularization and rapid clearance of vitreous hemorrhage. It can be used as an adjunctive therapy with laser photocoagulation and to enhance absorption of vitreous hemorrhage with subsequent deferral from vitrectomy.
Summary: Ten eyes having proliferative diabetic retinopathy were treated with intravitreal bevacizumab. Following injection, evident regression of retinal neovascularization and rapid clearance of vitreous hemorrhage as well as vision improvement was observed.
Keywords: intravitreal bevacizumab; proliferative diabetic retinopathy; retinal neovascularization; vascular endothelial growth factor; vitreous hemorrhage.
Figures
References
- Aiello LP, Brucker AJ, Chang S, et al. Evolving guidelines for intravitreal injections. Retina. 2004;24:13–19.
- Arevalo JF, Wu L, Sanchez JG, et al. Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy. Program and abstracts of “Cannes Retina Festival”; the joint meeting of the American Society of Retina Specialists and European Vitreoretinal Society; September 9–13; 2006. p. 213.
- Avery RL. Regression of retina and iris neovascularization after Intravitreal bevacizumab (Avastin) treatment. Retina. 2006;26:352–3.
- Avery RL, Pieramici DJ, Castellarine AA, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Program and abstracts of “Cannes Retina Festival”; the joint meeting of the American Society of Retina Specialists and European Vitreoretinal Society; September 9–13; 2006. p. 139.
- Bakri SJ, Snyder M, Pulido JS, et al. Pharmacokinetics of Intravitreal bevacizumab (Avastin). Program and abstracts of “Cannes Retina Festival”; the joint meeting of the American Society of Retina Specialists and European Vitreoretinal Society; September 9–13; 2006. p. 77.
- Beer PM, Wong S, Falk NS, et al. Vitreous levels of unbound bevacizumab and unbound vascular endothelial growth factor in two human subjects. Program and abstracts of “Cannes Retina Festival”; the joint meeting of the American Society of Retina Specialists and European Vitreoretinal Society; September 9–13; 2006. p. 77.
- Caldwell RB, Bartoli M, Behzadian MA, et al. Vascular endothelial growth factor and diabetic retinopathy: role of oxidative stress. Curr Drug Targets. 2005;6:511–24.
- Chew EY. Major clinical trials of vitreoretinal diseases. In: Regillo CD, Brown GC, Flyn HW, editors. Vitreoretinal disease, the essentials. New York: Theme Medical Publishers Inc; 1999. pp. 667–77.
- Davidorf FH, Mouser JG, Derick RJ. Rapid improvement of rubeosis from a single bevacizumab (Avastin) injection. Retina. 2006;26:354–6.
- Itakura H, Kishi S, Kotajima N, et al. Persistent secretion of vascular endothelial growth factor into the vitreous cavity in proliferative diabetic retinopathy after vitrectomy. Ophthalmology. 2004;111:1880–84.
- Iturralde D, Spaide RF, Meyerle CB, et al. Intravitreal bevacizumab (Avastin) treatment for macular edema in central retinal vein occlusion: A short term study. Retina. 2006;26:279–84.
- [MDRSG] Macugen Diabetic Retinopathy Study Group Changes in retinal neovascularization following Pegaptanib (Macugen) therapy in diabetic individuals. Ophthalmology. 2006;113:23–8.
- Malik RA, Li C, Aziz W, et al. Elevated plasma CD105 and vitreous VEGF levels in diabetic retinopathy. J Cell Mol Med. 2005;9:692–7.
- Manzano RPA, Peyman GA, Khan P, et al. Testing intravitreal toxicity of bevacizumab (Avastin) Retina. 2006;26:257–61.
- Spaide RF, Fisher YL. Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 2006;26:275–8.
- [DRSRG] The Diabetic Retinopathy Study Research Group Preliminary reports on effects of photocoagulation therapy. Am J Ophthalmol. 1976;81:383–96.
- [DRSRG] The Diabetic Retinopathy Study Research Group Photocoagulation treatment of proliferative diabetic retinopathy: Clinical applications of diabetic retinopathy study (DRS) findings, DRS report Number 8. Ophthalmology. 1981;88:583–600.
- Tolentino MJ, Miller JW, Gragoudas ES, et al. Intravitreal injection of vascular endothelial growth factor produce retinal ischemia and microangiopathy in an adult primate. Ophthalmology. 1996;103:1820–8.
- Tolentino MJ, McLeod DS, Toamoto M, et al. Pathological features of vascular endothelial growth factor-induced retinopathy in nonhuman primate. Am J Ophthalmol. 2002;133:373–85.
- Wilkinson-Berka JL. Vasoactive factors and diabetic retinopathy: Vascular endothelial growth factor, cycoloxygenase-2 and nitric oxide. Curr Pharm Des. 2004;10:3331–48.
Source: PubMed