Intravitreal Bevacizumab Therapy in Patients With Macular Capillary Nonperfusion Associated With Diabetic Retinopathy

Abstract

Purpose:: To evaluate the short-term visual acuity and fluorescein angiography (FA) effects and optical coherence tomography (OCT) findings, after intravitreal bevacizumab treatment for the management of patients with macular capillary nonperfusion associated with diabetic retinopathy.

Methods:: Non-randomized open-label study of intravitreal bevacizumab conducted at two tertiary vitreoretinal referral centers in Brazil. All patients with definite (''moderate'' or ''severe'') capillary non-perfusion associated with diabetic retinopathy (as assessed by non-simultaneous stereoscopic fluorescein angiograms according to Early Treatment Diabetic Retinopathy Study criteria [ETDRS Report No. 11]) were invited to participate. Patients were treated with intravitreal injection(s) of 1.5mg of bevacizumab and prospective evaluations performed at weeks 8 (±1), 16 (±2), and 24 (±2). Main outcome measures included changes in best-correct visual acuity (BCVA) , FA findings, and central macular thickness (CMT) and total macular volume (TMV) as assessed by OCT.

Results:: The mean (± SD) age of the 10 patients was 59.8 (±1.89) years. The mean number of injections was 1.9 (range, 1 to 3). Mean logMAR ETDRS (Snellen equivalent) BCVA was 0.786 (~20/125⁺¹) at baseline. Significant change in BCVA was detected throughtout the study (P = 0.005; multivariate analysis of variance). Mean BCVA was 0.646* (~20/80^-2) at 8 weeks, 0.58* (~20/80⁺¹) at 8 weeks, and 0.574* (~20/80⁺¹) at 24 weeks (*P< 0.001; Dunnett’s test). At 24 weeks, the mean change in BCVA from baseline was an improvement of 2.12 ETDRS lines (range, -0.2 line to +4.0 lines). Mean CMT (µm) / TMV (mm³) were, respectively, 467.9 ±10.9 at baseline, 371.4 ±9.9 at 8 weeks, 359.5 ±9.8 at 16 weeks, and 323.7 ±9.5 at 24 weeks. Changes in mean CMT and TMV throughout the study were not significant (P = 0.09 and P = 0.17, respectively; multivariate analysis of variance). At 24 weeks, FA demonstrated no change in total area of macular nonperfusion and reduced dye leakage as compared with baseline in all patients.

Conclusions:: Morphofunctional changes observed in the short term suggest that intravitreal bevacizumab may be a viable alternative treatment for the management of patients with diabetic retinopathy associated with macular capillary non-perfusion.

Keywords: diabetic retinopathy • edema • injection