Intravitreal Bevacizumab for Diabetic Papillopathy

Abstract

A 43-year-old woman presented with a visual acuity of 1/10 in the right eye and 3/10 in the left eye. Ophthalmologic examination disclosed optic disc swelling on both sides with mild nonproliferative diabetic retinopathy. The pupils were equal and reactive without an afferent pupillary defect. Visual field testing showed no significant defect in both eyes. Systemic investigations revealed no abnormality. The patient was injected with bevacizumab intravitreally with the diagnosis of diabetic papillopathy (DP). Three weeks later, the vision increased to 7/10 in the right eye and optic disc edema disappeared. Intravitreal injection of bevacizumab effectively treated DP.

Response of diabetic papillopathy to intravitreal bevacizumab

“…In addition to the recently reported case similar to ours,6 there are at least two other cases in the literature that support the response of ischemic optic neuropathies to bevacizumab. The first is a case of nonarteritic ischemic optic neuropathy in an 84-year-old woman who had marked clinical improvement 10 days after intravitreal bevacizumab injection 10.…”

“…The marked clinical resolution of diabetic papillopathy that occurred only in the eye injected with intravitreal bevacizumab strongly suggests that the injection altered the natural course of the condition and that VEGF is involved in the pathogenesis of diabetic papillopathy. A similar recently reported case also supports this idea 6. In our case, the macular hard exudates may have been related to the patient's diabetic retinopathy or may have specifically been part of the papillopathy 7…”

Diabetic Optic Neuropathy and Its Risk Factors in Chinese Patients With Diabetic Retinopathy

“…14 There is no association between DP and tight metabolic control or DR stage when only minimal OA has occurred. 15 However, edema associated with DP has a tendency to resolve, often resulting in no observable permanent sequelae (e.g., OA). 16 Our analyses show that eyes with PDR have a higher prevalence of DON (including DP) than eyes with NPDR.…”

Resolution of diabetic papillopathy after a single intravitreal injection of ranibizumab

“…Gradual resolution of the optic nerve head oedema and peripapillary retinal oedema was detectable at 2 weeks (third from top) and 7 months (bottom) after a single intravitreal injection of ranibizumab 0.5 mg. Final bestcorrected visual acuity was 0.9. previously been described, but without imaging studies (Ornek & Ogurel 2010). Our observations suggest that intravitreal inhibition of vascular endothelial growth factor may be of therapeutic benefit in eyes with diabetic papillopathy.…”