Characteristics of Macular Edema in Behcet Disease after Intravitreal Bevacizumab Injection

Abstract

Purpose: To investigate the effect of intravitreal bevacizumab (IVB) injection on macular edema (ME) secondary to Behcet's disease.

Methods: This prospective case series included 15 patients with bilateral ME due to Behcet's disease. Intravitreal bevacizumab was injected into the more severely involved eye; the contralateral eye was evaluated as the control. Patients were followed up with comprehensive ocular examination, optical coherence tomography, and fluorescein angiography (FA) for a minimum of 6 months by a single ophthalmologist.

Results: Patients with a mean age of 30.6 ± 7.4 years received a mean number of 3.3 IVB injections during the 6 months. The mean preinjection vision was 0.6 ± 0.3 and 0.4 ± 0.4 LogMAR in the case and control groups, respectively, with no significant improvement at 6 months. Mean central foveal thickness was 375.3 ± 132.1 and 307.2 ± 84.5 μm in the case and control groups, respectively, and these changed to 401 ± 199.9 (P = 0.65) and 307.7 ± 82.8 μm (P = 0.73) at month 6, respectively. A statistically nonsignificant improvement in ME was observed during the first 3 months in the case group. However, it did not persist up to month 6 on an as-needed basis. IVB injections caused a disproportionate decrease in the thickness of macular subfields. A reduction in disc leakage was observed on FA (P = 0.058). Logistic regression analysis revealed no statistically significant predictive factor for an improvement in visual acuity (VA) and a reduction in foveal thickness.

Conclusion: During a 6-month period, IVB injections based on an as-needed protocol provided no statistically significant improvement in VA and ME.

Keywords: Behcet's Disease; Intravitreal Bevacizumab; Macular Edema; Uveitis.

Figure 1

Changes in visual acuity (best corrected visual acuity [BCVA]; LogMAR) and central macular thickness (CMT; μm) after intravitreal bevacizumab injection in cases (group 1) and controls (group 2) during the 6-month follow-up period.

Figure 2

Changes in best corrected visual acuity (BCVA; LogMAR) and central macular thickness (CMT; μm) after intravitreal bevacizumab injection in cases (group 1) and controls (group 2) after removing the outliers (three refractory cases) during the 6-month follow-up period.

Figure 3

Optical coherence tomography (OCT) changes in the intravitreal bevacizumab (IVB)-injected eyes in five patients with Behcet's disease. The OCT changes in thickness after IVB injection at months 0, 1, 3, and 6 are shown consecutively.