Primary effects of intravitreal bevacizumab in patients with diabetic macular edema

Abstract

Objective: To evaluate the efficacy of primary intra vitreal bevacizumab (IVB) injection on macular edema in diabetic patients with improvement in best corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography (OCT).

Methods: This prospective interventional case series study was conducted at Retina Clinic, Al-Ibrahim Eye Hospital, and Isra Postgraduate Institute of Ophthalmology Karachi. Between December 2010 to June 2012. BCVA measurement with Early Treatment in Diabetic Retinopathy Study (ETDRS) charts and ophthalmic examination, including Slit-lamp bio microscopy, indirect ophthalmoscopy, Fundus fluorescein angiography (FFA) and OCT were done at the base line examination. At monthly interval all patients were treated with 3 injections of 0.05 ml intra vitreal injection containing 1.25 mg bevacizumab. Patients were followed up for 6 months and BCVA and OCT were taken at the final visit at 6 month.

Results: The mean BCVA at base line was 0.42±0.14 Log Mar units. This improved to 0.34±0.13, 0.25±0.12, 0.17±0.12 and 0.16±0.14 Log Mar units at 1 month after 1(st), 2(nd) 3(rd) injections and at final visit at 6 months respectively, a difference that was statistically significant (P>0.0001) from base line. The mean 1mm CMT measurement was 452.9 ± 143.1 µm at base line, improving to 279.8 ± 65.2 µm (P<0.0001) on final visit. No serious complications were observed.

Conclusions: Primary IVB at a dose of 1.25 mg on monthly interval seems to provide stability and improvement in BCVA and CMT in patient with DME.

Keywords: Best Corrected Visual Acuity (BCVA); Central Macular Thickness (CMT); Diabetic Macular Edema (DME); Intra Vitreal Bevacizumab (IVB).

Fig.1

Optical Coherence tomography (OCT) imaging of a 52 years old diabetic male with a history of loss of vision in both eyes to 20/160, Right eye (a) Left eye (b), in which diabetic macular edema had developed. The OCT shows a marked resolution in macular edema and improvement of Central Macular Thickness (CMT) after treatment

Fig.2

Changes in best corrected visual acuity (BCVA) after intravitrealbevacizumab (IVB). BCVA improved after 1^st injection from 0.42 Log Mar (baseline) to 0.34 Log Mar, a difference that was statistically significant (P<.0001), this improvement of BCVA was maintained throughout after 2^nd and 3^rd injections and final visit at 6 months