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N. Kunjukunju, C. R. Gonzales, W. S. Rodden; Bilateral Avastin Injections. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1876.
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To report on the safety and feasibility of bilateral intravitreal avastin therapy for neovascular age related macular degeneration administered the same day.
A retrospective of 76 consecutive eyes from 38 patients was performed. All patients underwent bilateral injections on the same day for macular degeneration. Patients with a history of stroke, hypertension, or cardiac disease were not excluded from receiving bilateral treatment. Patients were adequately anesthetized; their eyes were prepped with a dilute betadine solution (3.33%) and 0.05mL of Avastin (25mg/mL), for a final dose of 1.25 mg of medication, was injected into each eye using two separate single-use 1ml prefilled syringe. Systemic and ocular complications were noted at the following visit, which averaged 58 days after the initial bilateral injection. Patients were placed on vigamox and azopt after each visit. One physician (WR) injected each patient.
The 4 patients with a history of stroke, reported no changes in their cerebral vascular health. Additionally, no changes were reported in the blood pressure and cardiac status of 35 patients with a history of hypertension and the 13 patients with heart related abnormalities. One patient with a history of hypertension and alzheimer’s disease reported having a transient ischemic attack (TIA). The TIA occurred one year after receiving bilateral avastin injections; however, she was continuing to receive monocular injections at regular intervals at the time of the TIA. One patient reported redness and foreign body sensation, but had no evidence of corneal abrasion. There were no cases of vision loss, endophthalmitis or corneal abrasion as a result of the bilateral injections. Paracentesis was not performed in any patient. The mean pre-injection visual acuity (OD 20/91, OS 20/60) was not significantly different from the post-injection vision (OD 20/83, OS 20/71), when compared over the course of a year. The number of bilateral injections ranged from a minimum of one set of injections in certain patients to a maximum of eight consecutive injections in others. When averaged, approximately five bilateral consecutive injections were given over the course of one year to each individual in this cohort.
Patients with bilateral disease may warrant giving bilateral anti-VEGF injections. Based on this small series, there did not appear to be any serious or systemic complications from bilateral same day injections; however, larger studies are necessary to establish the safety of bilateral injections as many of the potential ocular and systemic complications are rare events.
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