Intravitreal Bevacizumab as a Treatment of Diabetic Macular Edema in Patients Refractory to Laser Photocoagulation Therapy
Ishan Yadav, Abhisek Mondal, Sanjay S Sen and Arnub Majumdar
World Journal of Medical and Surgical Ophthalmology 2015, 1:1
To evaluate the effectiveness of intravitreal Bevacizumab injection as treatment of Diabetic macular edema in patients who are not responding to previous photocoagulation.
Material and Methods
40 eyes of 40 diabetic patients were treated with 1.25 mg of intravitreal bevacizumab injection as the primary therapy for diabetic macular oedema. The main outcome measures included best-corrected visual acuity, fundus fluorescein angiography, and macular oedema map values of optical coherence tomography before and after intravitreal injections.
All the eyes had received some form of laser photocoagulation before (not less than six months ago), but all of these patients had persistent diffuse macular edema with no improvement in visual acuity. The visual acuity increased in 30 of 40 eyes (75%) during a mean follow-up time of 5.6 months. The mean baseline best-corrected Log MAR value for visual acuities of the patients before intravitreal bevacizumab injection was 1.09 ± 0.23. After treatment, it was 0.90 ± 0.17 at the 1-month, 0.81 ±0.24, at 3-month, and 0.77 ± 0.26 at the last visit examination and the differences were significant when compared with baseline values (for each, P<0.001). The mean edema map values significantly decreased by 33.3% at the last visit examination when compared with preinjection values (P<0.001). No adverse events were observed, including endophthalmitis, inflammation and increased intraocular pressure or thromboembolic events in any patient. Mild anterior chamber inflammation was observed in four eyes (10%), which resolved in a week with topical corticosteroid. No other injection- or drug-related complications were observed.
Initial treatment results of patients with diffuse diabetic macular edema not responding to previous photocoagulation did not reveal any short-term safety concern. Intravitreal bevacizumab application provides significant improvement in visual acuity of diabetic patients and clinical course of macular oedema, and may therefore be a promising approach in the primary treatment of diabetic macular oedema.