Purpose:
To report the 6-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) response after the combination of intravitreal adalimumab (Humira) and bevacizumab (Avastin) in patients with macular edema of various etiologies.
Methods:
Retrospective interventional case series. We reviewed the clinical records of 5 consecutive patients (7 eyes) with macular edema of various etiologies including pseudophakic macular edema, diabetic papillophlebitis, central retinal vein occlusion, branch retinal vein occlusion, and exudative age-related macular degeneration. All patients were treated with at least one intravitreal injection of 1.25 mg/0.05 mL of bevacizumab and 2 mg/0.08 mL of adalimumab . Patients underwent ETDRS BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline, 1-, 3- and 6-month visits. Main outcome measures included changes in BCVA, and OCT.
Results:
The mean age of our patients was 71.5 ± 9.4 years. The mean number of combined bevacizumab and adalimumab injections per eye was 2.14 (range: 1 to 4 injections) at 6 months. The baseline BCVA improved from 1.19 ± 0.6 logarithm of the minimum angle of resolution (logMAR) to 0.94 ± 0.59 logMAR at 6 months (P < 0.05). Four (57.1%) of seven eyes gained ≥ 3 ETDRS lines of BCVA. Central macular thickness (CMT) at baseline by OCT had a mean of 416 ± 150 µm which was reduced to a mean of 354 ± 205 µm at 6 months (P < 0.05). There were no ocular or systemic complications.
Conclusions:
Combined intravitreal bevacizumab at doses of 1.25 mg and adalimumab at doses of 2.0 mg seems to provide stability or improvement in BCVA, OCT, and FA in macular edema of various etiologies with no systemic complications at 6 months of follow up. Although limited by the small sample size, short follow-up, and lack of a control group, our results suggest potential bioactivity related to the favorable functional and anatomic outcome achieved.
Keywords: macula/fovea • edema • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials