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P. L. Tsai, K. M. Riaz, K. K. Kamat, N. J. Pathak, J. A. Rowe, R. M. Ahuja; Efficacy of Intravitreal Bevacizumab (Avastin) in Patients With Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2736.
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To determine the efficacy of intravitreal bevacizumab (Avastin) in patients with proliferative diabetic retinopathy with vitreous hemorrhage (VH) and/or iris neovascularization (NVI) not amenable to panretinal photocoagulation.
We performed a retrospective analysis in the Division of Ophthalmology at Stroger Hospital of Cook County of 75 eyes of 62 patients given intravitreal injections of bevacizumab for proliferative diabetic retinopathy. All patients enrolled received informed consent and a complete ophthalmic examination. Patients received 1.25 mg of bevacizumab in a 0.05 ml intravitreous dose. Post-injection examinations were performed between 1 to 3 days and then at 1 to 2 months, with additional follow-up as needed.
Of the 62 patients, 27 were female and 35 were male. The average age was 54 years (range 29-80 years). Patients were followed for a mean of 200 days (range 35-389 days). During this period, 68 eyes (91%) showed improvement of vitreous hemorrhage and/or NVI. Vitreous hemorrhage improved in 53 out of 62 eyes (85%), and NVI improved in 29 out of 30 eyes (97%). Of the eyes with NVI, 27 out of 30 eyes (90%) showed complete resolution, the earliest occurring 1 day post injection (mean 44 days). Eleven eyes of 10 patients (15%) received a second injection of bevacizumab over the course of follow-up for either recurrent vitreous hemorrhage and/or NVI (7 for VH, 2 for NVI, and 2 for both), and one patient received a third injection of bevacizumab (for VH and NVI). No adverse events were seen during the entire follow-up period.
In this study with extended follow-up, intravitreal bevacizumab (Avastin) injection appears to be both safe and well tolerated in patients with proliferative diabetic retinopathy. Rubeosis iridis responded particularly well to treatment with rapid resolution in nearly all eyes. Although vitreous hemorrhage resolved completely in less than 20% of patients, clearance was observed in over 85% of the patients, which subsequently permitted panretinal photocoagulation. Re-injection was required in 11 eyes for either recurrent vitreous hemorrhage and/or NVI. Additional study is necessary to determine the long-term safety and efficacy of intravitreal bevacizumab in patients with proliferative diabetic retinopathy.
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