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Kanishka Mendis, Ana Galevska-Dimitrovska, Rhiana Thompson, Bruce Shadbolt; The effect of the reflux bleb of anti-VEGF injections on central macular thickness. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3802.
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Purpose: To investigate the effect of the reflux bleb (RB) associated with intra vitreal anti-vascular endothelial growth factor (anti-VEGF) injections on central macular thickness (CMT- central sub-field of Cirrus spectral domain ocular coherence tomography- Cirrus SD OCT- Carl Zeiss Meditec, Dublin, CA)
Methods: Prospective, consecutive, observational, pilot study of patients administered anti-VEGF therapy (Bevacizumab and Ranibizumab- Genentech Inc, South San Francisco, CA) for wet age related macular degeneration, macular oedema secondary to branch and central vein occlusion, exudative diabetic maculopathy, myopic choroidal neovascular membrane and idiopathic polypoidal choroidal vasculopathy. The bleb status following an anti-VEGF injection, the CMT1 and the CMT2 at the immediate next visit were recorded prospectively in all patients (fig. 1). Generalised linear models and logistic regression were used to evaluate the effect of bleb status on the difference between CMT1 and CMT2. The analyses adjusted for age, gender, time between injections, laterality, diagnosis and anti-VEGF agent. The statistical package used to run the analysis was SPSS v19.0.
Results: The bleb status of 100 eyes was prospectively recorded. A post injection bleb was observed on 42% of eyes (42/100). There were an equal number of right and left eyes. There were 67 Bevacizumab injections and 33 Ranibizumab injections. The mean age of the patients was 73 years, and there were 53 females and 47 males. Patients without a post injection bleb were 2.3 times more likely (95% CI = 0.9, 5.7) to have a reduction in CMT than those with a bleb (p=0.08).
Conclusion: This pilot project has provided some evidence that the development of a post injection bleb maybe associated with less of a reduction in CMT. The results indicate that a larger study is worth undertaking that includes a longer follow-up period.
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