Regression of Retinal and Iris Neovascularization From Diabetes Following Intravitreal Bevacizumab (Avastin®)

Abstract

 

Purpose:

 

To evaluate the short term safety and biologic effectof intravitreal bevacizumab on retinal and iris neovascularization(NV) secondary to proliferative diabetic retinopathy (PDR).

 

Methods:

 

A retrospective review of consecutive patients receivingintravitreal bevacizumab for PDR at two clinical practices wasperformed after IRB approval. Retinal and iris NV was evaluatedby fluorescein angiography.

 

Results:

 

Thirty eyes of 26 patients underwent intravitreal injectionof doses of bevacizumab ranging from 12.5 ug to 1.25 mg. Nosignificant ocular or systemic side effects were observed. Allpatients demonstrated reduction or absence of angiographic leakageof NV following injection, sometimes within 1 day. The NV alsoappeared to involute in most patients with a dramatic reductionin the caliber of perfused blood vessels as shown below: (A)Pre–injection and (B) 1 week following injection of 125ug of bevacizumab. In several patients, after injection of thehighest dose (1.25mg), a subtle reduction in leakage of irisor retinal NV was observed in the fellow, un–injectedeye.  

 

 

Conclusions:

 

This short term study demonstrates proof of principlethat intravitreal bevacizumab can cause at least short termregression of retinal and iris NV secondary to PDR. The evidenceof a biologic effect at 1/100^th the standard dose and the observationof effects in the fellow eye raise concerns of possible systemiceffects from use of this potent agent. Further study includinglong term follow–up is needed to evaluate bevacizumab’spotential role in the treatment of PDR.

 

Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • diabetes • neovascularization