Abstract
Purpose::
To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR).
Methods::
Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Main outcome measures included changes in RN on ophtalmoscopic examination and FA.
Results::
Forty-four eyes of 33 patients with PDR and a mean age of 57.2 years old (range from 23 to 82 years old) participated in the study. Thirty-three eyes (75%) were unresponsive to previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). Best-corrected visual acuity and OCT demonstrated improvement (p < 0.0001). Three eyes without previous PRP ("naive eyes") and with vitreous hemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous hemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed.
Conclusions::
Intravitreal bevacizumab resulted in marked regression of RN on fundus examination and FA in patients with PDR unresponsive to PRP, and rapid resolution of vitreous hemorrhage in 3 naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg in patients with PDR do not reveal any safety concerns. The favorable results suggest that further study is needed in a larger group of patients.
Keywords: diabetic retinopathy • retinal neovascularization • proliferation