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Peter A. Karth, Annie Chang, William Wiroskto; Predicting the Response to Intravitreal Anti-VEGF Based On the Response In the Fellow Eye In Clinically Significant Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4666.
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Currently it is unknown if treatment with intravitreal bevacizumab in the fellow eye should be altered based on the response of the first eye to intravitreal bevacizumab in clinically significant diabetic macular edema (CSDME). In this study, we assess the predictability of response to intravitreal bevacizumab in fellow eyes based on the response to intravitreal bevacizumab in the first eye in CSDME.
Retrospective chart review was conducted on 28 patients (56 eyes) with bilateral CSDME who underwent bilateral bevacizumab therapy. Responses in both eyes were measured by change in central foveal thickness (CFT) via optic coherence tomography (OCT), and change in visual acuity. Age, lens status, and starting macular thickness were recorded.
In CSDME, 21% of the response (reduction in CFT) to intravitreal bevacizumab on OCT in the fellow eye may be explained by the percentage change in CFT in the first eye [CI: 0.092 - 0.716; P value is 0.0141]. Also, the pre-injection CFT predicts 14% of the response to bevacizumab in the same eye [R2=14%, P-value = 0.0041]. When combined in a multi-factorial model, 33% of the change in CFT following intravitreal bevacizumab may be explained by these two factors. Lens status, change in visual acuity, and age were not statistically significant predictors of response.
Identifying factors that can aid in predicting the response to intravitreal bevacizumab in the fellow eye based on the response to treatment in the first eye may assist clinicians in the decision to institute or abandon treatment in the setting of CSDME. Our data indicates that the response to bevacizumab in the fellow eye is partially explained by the response in the first eye to bevacizumab and by the pre-injection CFT in the fellow eye. Lens status, change in visual acuity, and age were not statistically significant predictors of response.
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