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A. Gabrielian, D. F. Kiernan, S. M. Hariprasad, T. Lin, W. F. Mieler; Effect of Intravitreal Bevacizumab for Retinal Disease on Injected and Fellow Eyes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4570. doi: https://doi.org/.
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Previous studies have demonstrated a short-term effect of intravitreal anti-VEGF agents on the fellow eye of patients with age-related macular degeneration (AMD). The purpose of this study is to determine whether intravitreal bevacizumab affects the logarithm of the minimum angle of resolution visual acuity (VA) and central macular thickness (CMT), measured by optical coherence tomography (OCT), of injected (IE) and fellow eyes (FE) in patients with non-AMD retinal disease.
A retrospective study of 76 injections (n=28) receiving intravitreal bevacizumab between January 2006 and October 2007. Analysis included diagnosis, pre and post-injection VA and CMT, with follow-up within 6 weeks. Patients with prior injections were excluded.
Overall mean pre and post-injection VA in treated eyes was 1.28 and 0.48 (p=0.05), and in FE it was 0.48 and 0.51 (p=0.2) respectively. Mean CMT change in IE vs. FE was (-86µm, p<0.0001) vs. (-6µm, p=0.31). In eyes with macular edema secondary to vein occlusion (n=11) mean pre and post-injection VA was 1.16 and 1.5 in IE (p= 0.29) vs. 0.34 and 0.40 (p=0.01) in FE respectively. Mean CMT decreased in IE (-123 µm, p=0.006) and FE (-22µm, p=0.42). In diabetic macular edema (n=9) mean pre and post-injection VA was 1.53 and 1.35 in IE (p= 0.09), vs. 0.6 and 0.64 (p=0.23) in FE respectively. Mean CMT decreased in IE (-102 µm, p=0.05) and FE (-2 µm, p=0.32). In eyes with CNV (n=3) mean pre and post-injection VA in treated eyes was 0.61 and 0.59 (p= 0.42) vs. 0.1 and 0.13 (p=0.3) in fellow eyes respectively. Post-injection mean CMT decreased in IE (-58µm, p=0.001) and FE (-2µm, p=0.27). In eyes with other diseases [telangiectasia (n=1), cystoid macular edema (n=1), radiation retinopathy (n=1), central serous retinopathy (n=1), proliferative vitreoretinopathy (n=1)] mean pre and post-injection VA in treated eyes was 1.29 and 1.14 (p=0.17) vs. 0.16 and 0.095 (p=0.05) in fellow eyes respectively. Mean CMT decreased in IE (-76 µm, p=0.105) but not in FE (0 µm, p=0.04).
Intravitreal bevacizumab is effective in decreasing CMT in eyes treated for all causes. There is a trend for treated eyes to show VA improvement, and this effect is more pronounced in eyes with ME secondary to DM. During the course of our study, it was noted that there was visual worsening in the fellow eye in all groups except "other", though there was no significant change in CMT. Though bevacizumab does not appear to have significant effects on CMT of fellow eyes, patients receiving intravitreal bevacizumab should be monitored closely for visual acuity change in the fellow eye.
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