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H. L. Oliveira Neto, A. Oliveira, R. Reis; Intravitreal Bevacizumab (Avastin) in the Treatment of Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1414.
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To report the short-term anatomic and visual acuity response after intravitreal bevacizumab (Avastin, Genentech) in patients with proliferative diabetic retinopathy.
Interventional, consecutive, prospective, case series. Forty-five eyes of 35 patients with retinal neovascularization secondary to diabetes mellitus. Patients with neovascularization secondary to diabetes mellitus associated or not with macular edema and vitreous hemorrhage received intravitreal bevacizumab (1.25 mg). Ophthalmic evaluations included nonstandardized Snellen visual acuity (VA), complete ophthalmic examination, fluorescein angiography, and optical coherence tomography (OCT). Change in fluorescein angiographic leakage of the proliferative diabetic retinopathy (PDR). Secondary outcomes included changes in Snellen VA and OCT.
The patients were 16 to 82 years old (median: 62,36). Male was 9/35 (25,7%) and female 26/35 (74,3%). All patients with neovascularization demonstrated by fluorescein angiography and (45/45 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within one to two weeks after the injection. Macular edema was observed in 18/45 (40%) patients. In addition to the reduction in angiographic leakage, the macular edema clinically appeared to involute in many patients with a reduction in 30-60 days. Twelve patients (26,7%) had proliferative diabetic retinopathy with vitreous hemorrhage. Following intravitreal injection of bevacizumab these patients experienced improvement in visual acuity starting within the first 2 weeks. At 1 month of follow-up six patients had 2 lines of improvement in visual acuity and three others, 5 lines. Each patient had regression of retinal neovascularization at 1 month of follow-up. Recurrent leakage was seen as early as 2 weeks in two cases, whereas in other cases, no recurrent leakage was noted at last follow-up of 11 weeks. Recurrent leakage was seen as 13 weeks in one case following intravitreal re-injection of bevacizumab. No significant ocular or systemic adverse events were observed.
Initial treatment results of intravitreal injection of bevacizumab (1.25 mg) in patients with proliferative diabetic retinopathy suggest that intravitreal bevacizumab is well tolerated and associated with a rapid regression of retinal neovascularization secondary to proliferative diabetic retinopathy. Intravitreal bevacizumab resulted in regression of macula edema and vitreous hemorrhage.
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