Treatment of refractory diffuse diabetic macular edema with lntravitreal bevacizumab

ABSTRACT

To analyze the short term visual acuity and anatomic response after a single dose of off-label intravitreal injection of bevacizumab in diffuse diabetic macular edema [DME] not responding to conventional laser photocoagulation. Prospective analysis of consecutive case series of 45 eyes of 38 patients with refractory diffuse DME who had one intravitreal injection of 1 .25 mg of bevacizumab [Avastin] and followed up for 3 months. All patients passed at least six months since their last laser treatment before inclusion in the study. Patients underwent best corrected visual acuity determination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula and measurement of the retinal thickness by optical coherence tomography [OCT] at base line and follow up visits. At 1 month post-injection, visual acuity improved by 1 line in 7 eyes, unchanged from the pre-injection levels in 24 eyes and deteriorated in 14 eyes. At 3 months post injection, visual acuity improved in 1 8 eyes, it remained unchanged in 13 eyes and deteriorated in 14 eyes. The mean logMAR visual acuities were 0.60 [SD +/- 0.34], 0.64 [SD +/- 0.31] and 0.61 [SD +/- 0.32] at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean decrease in vision was statistically not significant [P value=0.099]. The foveal thickness on optical coherence tomography had decreased in 27 eyes and it increased in 1 8 eyes at 1 month post-injection. At 3 months following injection, foveal thickness was reduced in 34 eyes, but was increased in 11 eyes. The mean foveal thicknesses were 444.95 micro [SD +/- 1 27.36], 394.95 micro [SD +/- 138.03] and 378.32 micro [SD +/- 112.01] at pre-injection, 1 month post-injection and 3 months post-injection respectively. This decrease in the foveal thickness was statistically significant [P value<0.001]. Intravitreal bevacizumab is effective in patients with diffuse DME which is refractory to treatment with conventional macular laser photocoagulation