Intravitreal bevacizumab (avastin) for proliferative diabetic retinopathy: 6-months follow-up

Abstract

Aims To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR). Methods Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 or 2.5 mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits.Results Forty-four eyes of 33 patients with PDR and a mean age of 57.2-years (range: 23-82 years) participated in the study. Thirty-three eyes (75%) had previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). BCVA and OCT demonstrated improvement (Po0.0001). Three eyes without previous PRP ('naive' eyes) and with vitreous haemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous haemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed. Conclusions Intravitreal bevacizumab resulted in marked regression of RN in patients with PDR and previous PRP, and rapid resolution of vitreous haemorrhage in three naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 or 2.5 mg in patients with PDR do not reveal any safety concerns.

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

“…Furthermore, Arevalo et al reported a dose-dependent response that 2.5 mg dosage seemed to be more effective than the 1.25 mg to have complete NV regression in naïve eyes. 20 Nevertheless, in a recent biologic study, a possible therapeutic effect in the fellow eye raises concern that systemic side effects are possible in patients undergoing intravitreal bevacizumab (6.2 mg-1.25 mg) treatment, and a lower dose regimen may achieve a therapeutic result with less risk of systemic side effects. 11 Further study of the optimal dosing of intravitreal bevacizumab in treating PDR is indicated.…”

“…In literature, the progression to TRD from a preexisting fibrovascular tissue contraction is a risk in few cases after intravitreal bevacizumab. 10,20,22 Furthermore, Arevalo et al reported the development or progression of TRD in 5.2% patients with severe PDR following intravitreal bevacizumab. 23 Cautious echographic examinations should be done before intravitreal bevacizumab to exclude the patients with broad vitreoretinal adhesion.…”

“…Doses of bevacizumab used in the literature have ranged from 1.25 to 2.5 mg. 10,11,20,21 We chose the higher dose of 2.5 mg in this study in the hopes of prolonging the therapeutic effect and reducing the number of repeated injections. The average number of injections in this study was 1.4 in a 6-month follow-up.…”

Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: The DRIVE UK Study

“…3 Since the Diabetic Retinopathy Vitrectomy Study over 25 years ago, there has been significant advancement in surgical techniques such as the use of a wide-angled viewing system, use of a perioperative endolaser, 4,5 small-gauge vitrectomy, and use of anti-vascular endothelial growth factor adjuvants before surgery. 6 Also, with the early diagnosis of disease from screening, one would predict that the prevalence of this end-stage condition is decreasing and the visual outcomes are improving.…”

Pharmacotherapy for Treatment and Prevention of Proliferative Diabetic Retinopathy

“…Uncontrolled case series have demonstrated that bevacizumab could induce complete regression of neovascularization, as assessed by ophthalmoscopy and/ or fluorescein angiography, in 61.4-100 % of participants. Regression could occur as early as 1 week and as late as 1 month post-injection, with cases of recurrence 2 weeks to 3 months after initial treatment [34][35][36][37][38][39][40]. Filho et al [41] conducted a randomized controlled trial comparing PRP to PRP with ranibizumab given as a single 0.5 mg injection after the first of two laser sessions; retreatment with ranibizumab in the combined group and additional PRP in the laser only group were given at 16 and 32 weeks after baseline.…”