Primary Intravitreal Bevacizumab for Diffuse Diabetic Macular Edema

Arévalo, J. Fernando; Sánchez, J. García; Wu, Lihteh; Maia, Maurício; Alezzandrini, Arturo; Brito, Miguel; Bonafonte, Sergio; Lujan, Silvio; Díaz-Llopis, M.; Restrepo, Natalia; Rodriguez, Francisco J.; Udaondo, Patricia

doi:10.1016/j.ophtha.2009.03.016

Cited by 108 publications

(36 citation statements)

References 62 publications

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“…Previous studies using anti-VEGF agents for DME showed potential benefit in maintaining or improving VA and reducing retinal thickness [24,28]. Also, intravitreal injections of an aptamer (pegaptanib sodium) in patients with DME have been shown to improve VA and retinal thickening [29].…”

Section: Discussionmentioning

confidence: 99%

“…Bevacizumab (Avastin®; Genentech, Inc., South San Francisco, Calif., USA), which is a full-length humanized monoclonal G1 antibody, has emerged as a therapeutic agent for retinal diseases, especially age-related macular degeneration [20,21,22,23], and has been shown to yield improvements in visual acuity (VA) with favorable anatomic results. Trials of anti-VEGF inhibitors in patients with retinal diseases, such as retinal vein occlusion and DME, have shown that primary intravitreal bevacizumab (IVB) seems to provide stable or increased VA [24,25,26]. …”

Section: Introductionmentioning

confidence: 99%

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Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

2010

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Purpose: To identify optical coherence tomography (OCT) patterns of diabetic macular edema (DME) predictive of visual outcomes after intravitreal bevacizumab (IVB; Avastin®) injection. Methods: We retrospectively examined 56 consecutive eyes that were given IVB injections for DME alongside the preoperative macular OCT data. Using this information, we categorized the eyes into 2 groups: group 1 showing diffuse patterns; group 2 demonstrating cystoid macular edema (CME). Result: The mean follow-up period was 11.66 ± 3.98 months. Group 1 eyes gained 0.04 ± 9.27 ETDRS letters (p = 0.984), while group 2 eyes gained 5.79 ± 9.98 ETDRS letters (p = 0.005). Mean macular thickness decreased by 72.79 ± 145.74 µm in group 1 (p = 0.014) and by 223.71 ± 224.52 µm in group 2 (p< 0.001). Conclusion: Patients showing CME upon OCT achieved greater improvements in visual acuity and macular thickness after IVB injection than patients with diffuse macular edema. The type of macular edema shown by OCT may provide an objective guideline in predicting the response of DME to IVB injection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

2010

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“…Diffuse DME can be effectively treated by means of IVTA or anti-VEGF drugs [21,22,23,24]. When a patient responds positively to the therapy, showing a reduction in DME on optical coherence tomography, a laser application following the ETDRS parameters should be recommended to consolidate the result.…”

Section: Treatment Algorithm For Dmementioning

confidence: 99%

Steroids as Part of Combination Treatment: The Future for the Management of Macular Edema?

et al. 2010

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Diabetic macular edema (DME), defined as a retinal thickening involving or approaching the center of the macula, plays a major role in vision loss related to diabetic retinopathy. This article presents an in-depth analysis of therapeutic perspectives on DME by means of an approach based on combination therapy with steroids. Corticosteroid drugs have been demonstrated to both inhibit the expression of vascular endothelial growth factor (VEGF) and the VEGF gene, and to have antiinflammatory properties. A treatment algorithm is provided regarding the management of DME. While grid laser photocoagulation remains the first-line therapy for focal vasogenic DME, diffuse DME can be effectively treated by means of intravitreal injections of corticosteroids. Recalcitrant DME can also be managed beneficially with intravitreal steroids. The management of DME is complex, and often multiple treatment approaches are needed. Each form of DME should be properly classified and specifically treated. The combination treatment has still an important role in the combined treatment options for DME.

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“…It is, therefore, of clear interest to analyze the factors that may be associated with an optimal (BCVA improvement of 10 letters) or suboptimal (BCVA improvement of less than 10 letters) response to treatment [15,16,17,18]. …”

Section: Introductionmentioning

confidence: 99%

Degree of Decrease in Central Retinal Thickness Predicts Visual Acuity Response to Intravitreal Ranibizumab in Diabetic Macular Edema

Santos

Gomes

Figueira³

et al. 2013

Ophthalmologica

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Purpose: To characterize factors that may be associated with optimal or suboptimal response to ranibizumab intravitreal injections in diabetic macular edema (DME). Methods: Fifty-nine eyes with DME treated with ranibizumab were included. All underwent best-corrected visual acuity (BCVA) assessment and optical coherence tomography (OCT) at baseline, 3 and 6 months. Central retinal thickness (CRT) was assessed at each visit, and OCT images were classified according to their morphological patterns. Results: A mean BCVA increase of 4.78 and 5.52 letters, and a CRT decrease of 80.25 and 106.12 µm were found after 3 and 6 months of treatment (p < 0.001). BCVA improvement was found to be dependent on baseline BCVA and the degree of CRT decrease. Twenty-six eyes (44%) showing a CRT decrease ≥20% improved BCVA by 10.3 ± 13.0 letters, whereas 33 eyes (56%) with a CRT decrease <20% had BCVA improvement of 1.8 ± 7.2 letters (odds ratio = 3.31). Conclusions: The degree of CRT decrease obtained by spectral-domain OCT identifies well the optimal responders to intravitreal ranibizumab and predicts BCVA improvement after treatment.

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Primary Intravitreal Bevacizumab for Diffuse Diabetic Macular Edema

Cited by 108 publications

References 62 publications

Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Features of Optical Coherence Tomography Are Predictive of Visual Outcomes after Intravitreal Bevacizumab Injection for Diabetic Macular Edema

Steroids as Part of Combination Treatment: The Future for the Management of Macular Edema?

Degree of Decrease in Central Retinal Thickness Predicts Visual Acuity Response to Intravitreal Ranibizumab in Diabetic Macular Edema

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