Intravitreal bevacizumab (Avastin^®) in proliferative diabetic retinopathy

Abstract

. Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab in proliferative diabetic retinopathy (PDR) patients. Methods: This interventional case series study included 15 eyes of 10 patients with bilateral PDR: 13 eyes with severe PDR and active new vessels (NV) and two eyes with recurrent vitreous haemorrhages. Study eyes received a single intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. All eyes were followed up for 3 months, and eight of them for 9 months. Reinjection was performed in three eyes 4–6 months after the first injection. Study eyes were evaluated by fluorescein angiography at baseline, 1, 3 and 9 months. Quantitative planimetric analysis (QPA) of NV area was measured before and after treatment. All eyes received or completed panretinal photocoagulation (PRP) 1 month after the first injection. Results: As early as at 1 month, all study eyes had a regression (paired t‐test, P = 0.01) of QPA‐estimated NV area. The eyes with recurrent vitreous haemorrhages had clearing of bleeding. These early effects were maintained at 3 months for all eyes and tended to be stable at 9 months. The fast and measurable efficacy of bevacizumab allowed a subsequent complete and safe PRP. Conclusion: Intravitreal bevacizumab did not reveal any side‐effects and was effective in the regression of NV areas and the resolution of vitreous haemorrhages. This approach is potentially useful in allowing (within a planned temporal window) a safe and efficient PRP to be performed while minimizing the risk of its complications.

A review of anti-VEGF agents for proliferative diabetic retinopathy

“…Minnella et al 40 reported that the early effects of bevacizumab were maintained at 3 months in 15 injected eyes. Likewise, Schmidinger et al 41 reported that 62% (8 of 13) of eyes required retreatment with bevacizumab at a 3-month follow-up visit because of the reappearance of new vessels.…”

Succinate Increases in the Vitreous Fluid of Patients With Active Proliferative Diabetic Retinopathy

“…5 Previous reports on the intravitreal injection of bevacizumab showed promise in targeting VEGF-implicated intraocular neovascularization that is associated with age-related macular degeneration and diabetic retinopathy. [6][7][8][9][10] Recently, intravitreal bevacizumab injection has also gained popularity among vitreo-retinal surgeons as an adjunct to vitrectomy in the management of severe PDR. [11][12][13] Other growth factors and cytokines including angiopoietin-2, 14 insulin-like growth factor-1, 15 erythropoietin, 16 hypoxia-inducible factor, 17 platelet-derived growth factor, 18 fibroblast growth factor-2 19 and hepatocyte growth factor 20 have also been demonstrated to be involved in ocular angiogenesis.…”

Bevacizumab Therapy for Choroidal Melanoma

“…It has been shown to reduce neovascular activity and vascular permeability in ocular tissues. 4,5 Nevertheless, despite the overexpression of VEGF in uveal melanoma, 2 at present no anti-angiogenic drug has been shown to clinically suppress tumour growth. 6 Currently, standard therapies include enucleation, local resection or radiotherapy, either by proton beam irradiation, stereotactic or brachytherapy (iodine or ruthenium).…”