Abstract
Introduction: :
E. Marcus, MD, C. Fay, M.A. Zarbin, MD, N. Bhagat, MD
Purpose: :
To determine the safety and efficacy of Lucentis intravitreal injections in diabetic eyes with rubeosis and advanced cataracts where panretinal photocoagulation (PRP) laser is precluded due to a poor view to the fundus.
Methods: :
A prospective pilot study. Protocol involved 3 monthly intravitreal injections of Lucentis (0.5 mg in 0.05 mL) for rubeosis. The cataract surgery was performed 7-10 days after the first injection. Lucentis injections with PRP laser were performed if rubeosis recurred or persisted after 3 months.
Results: :
Two diabetic eyes of two subjects with rubeosis and advanced cataracts were recruited. Average baseline ETDRS visual acuity of the study eyes was 20/280 (converted to logMAR, approximately 2.15). Both eyes received the 3 Lucentis injections per protocol and were free of rubeosis at days 5 and 18 after the first injection respectively, with no adverse events. IOP remained normal in both eyes. One of the two eyes required no further treatment beyond the 3 months with Lucentis or PRP, showed no signs of rubeosis after the first injection, or any signs of advancing proliferative disease beyond the third. No adverse events were reported in this subject during the study. The second eye showed complete resolution of rubeosis after the first Lucentis injection and cataract surgery. The eye, however, showed signs of advancing proliferative disease at month 6 and 10, and received both Lucentis and PRP at those times. The second subject who had an history of coronary artery disease experienced a silent MI at month 8, exacerbations of congestive heart failure at months 12 and 14, and MRSA bacteremia (from an infected foot ulcer) at month 13 as extraocular adverse events.
Conclusions: :
Lucentis seems to be an effective way of treating rubeosis in eyes with advanced cataracts who cannot receive immediate PRP. In one eye the Lucentis injected led to complete regression of rubeosis with no recurrence in the 1 year follow-up period; in the second eye, PDR (but not rubeosis) occurred at months 6 and 10 (3 and 7 months respectively after the last Lucentis dose).
Keywords: diabetic retinopathy • cataract • vascular endothelial growth factor