Intravitreal bevacizumab as a primary treatment for idiopathic choroidal neovascularization.

PURPOSE: To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization (ICNV). MATERIALS AND METHODS: Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity (BCVA), presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography (OCT) or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. RESULTS: The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months (range, 8 months to 20 months). Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR (P=0.031). The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 ± 146.52 and 347.16 ± 213.97 to 251.20±35.36 and 215.33 ± 43.94 µm, respectively. (P = 0.99 and P = 0.16, respectively). Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. CONCLUSION: Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects.

Role of intravitreal bevacizumab (Avastin) injected at the end of diabetic vitrectomy in preventing postoperative recurrent vitreous hemorrhage.

PURPOSE: The purpose of this study was to evaluate the role of bevacizumab (Avastin), an antivascular endothelial growth factor agent, injected at the end of surgery for preventing postoperative recurrent vitreous hemorrhage in patients undergoing vitrectomy for diabetic eye disease. METHODS: This was a retrospective, comparative, and nonrandomized study on a consecutive series of patients who underwent vitrectomy for diabetic eye disease. Recurrence of postoperative vitreous hemorrhage was compared in patients with and without intravitreal 1.25 mg bevacizumab given at the end of surgery. RESULTS: During the study period, 58 patients had vitrectomy for diabetic disease. In 33 patients (the control group), no intravitreal bevacizumab was injected at the end of surgery, and in 25 patients (the intervention group) intravitreal bevacizumab 1.25 mg/0.05 mL was injected at the end of surgery. Both groups were matched for the number of patients, age, sex, diagnosis, and status of systemic disease. Recurrent postoperative vitreous hemorrhage was noted in 14 patients in the control group (14 of 33, 42.40%) and in 1 patient in the intervention group (1 of 25, 4.0%). The difference in postoperative vitreous hemorrhage between the 2 groups was statistically significant (P = 0.001). There was no statistical difference in the mean postoperative visual acuity between the 2 groups during the follow-up period (P = 0.410). CONCLUSION: Intravitreal injection of 1.25 mg bevacizumab given at the end of vitrectomy appears safe and effective for reducing the incidence of recurrent postoperative vitreous hemorrhage after diabetic vitrectomy. Further randomized studies should be performed to evaluate the potential of this therapy in preventing postoperative recurrent vitreous hemorrhage after diabetic vitrectomy.

Role of residual vitreous cortex removal in prevention of postoperative vitreous hemorrhage in diabetic vitrectomy.

AIM: To evaluate whether residual vitreous cortex removal has a role in the prevention of postoperative vitreous hemorrhage in diabetic vitrectomy. METHODS: Retrospective, comparative, nonrandomized study on a consecutive series of patients who underwent vitrectomy for diabetic eye disease. Recurrence of postoperative vitreous hemorrhage was compared in patients following surgery with and without residual vitreous cortex removal. RESULTS: During the study period, 59 patients had vitrectomy for diabetic disease. In 31 patients (group 1), the residual vitreous cortex was not removed and in 28 patients (group 2) the residual vitreous cortex was removed during surgery. Both groups were matched for number of patients, age, sex, duration of follow-up, and diagnosis. Recurrent postoperative vitreous hemorrhage (RVH) was noted in ten patients in group 1 (10/31, 32.25%) and in two patients in group 2 (2/28, 7.14%). The difference in postoperative vitreous hemorrhage between the two groups was statistically significant (P = 0.017). Logistic regression analysis showed that residual vitreous cortex removal and presence of intravitreal gas tamponade were associated with reduced risk of postoperative vitreous hemorrhage. However, only residual vitreous cortex removal was statistically significant factor in reducing risk of postoperative vitreous hemorrhage [odds ratio = 0.174; confidence interval (CI) = 0.0331-0.919; P = 0.040]. CONCLUSION: Residual vitreous cortex removal may be beneficial in reducing recurrence of postoperative vitreous hemorrhage following diabetic vitrectomy. Further randomized studies should be performed to evaluate the potential of this surgical technique in preventing postoperative recurrent vitreous hemorrhage following diabetic vitrectomy.

Role of combined cataract surgery and intravitreal bevacizumab injection in preventing progression of diabetic retinopathy: prospective randomized study.

PURPOSE: To evaluate the role of intravitreal bevacizumab, an anti-vascular endothelial growth factor agent, injected at the time of cataract surgery on the postoperative progression of diabetic retinopathy (DR) and diabetic maculopathy. SETTING: Tertiary-care eye specialty hospital, Dhahran, Kingdom of Saudi Arabia. METHODS: Patients were randomized to a standardized procedure of phacoemulsification with intraocular lens implantation alone (control group) or to receive 1.25 mg intravitreal bevacizumab at the end of surgery (intervention group). Diabetic retinopathy and maculopathy were assessed at each postoperative visit during a 6-month follow-up. RESULTS: Sixty-eight eyes (68 patients) with DR and cataract were recruited for this prospective study. Progression of DR occurred in 15 (45.45%) of 33 eyes in the control group and 4 (11.42%) of 35 eyes in the intervention group (P = .002) Progression of diabetic maculopathy occurred in 17 eyes (51.51%) in the control group and 2 eyes (5.71%) in the intervention group (P = .0001). There was no statistically significant difference in postoperative visual acuity between the 2 groups (P = .772). Two eyes in the control group and none in the intervention group progressed to neovascular glaucoma. The mean postoperative central macular thickness and mean macular thickness were not statistically significantly different between the 2 groups (P = .874 and .942, respectively). CONCLUSION: Intravitreal administration of 1.25 mg bevacizumab at the time of cataract surgery was safe and effective in preventing the progression of DR and diabetic maculopathy in patients with cataract and DR.