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Sandeep Grover, Kumar Sambhav; Plateau-effect of intravitreal bevacizumab after six injections in diabetic macular edema. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3611. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze outcomes of diabetic macular edema (DME) treated with intravitreal bevacizumab (IVB), using treat-and-extend algorithm.
This is a retrospective review of patients with DME, who were treated with IVB over a 10-year period, who received at least 3 injections every 4 - 6 weeks by the same retina specialist. Baseline measurements for visual acuity (VA) and central macular thickness (CMT) were obtained before undergoing a series of 3 injections. If there was persistent DME, another course of 3 injections of IVB were given. The injections were stopped if the DME resolved - it was restarted back on a PRN basis, if the CMT increased or VA decreased. The CMT and VA on their last visit was considered as the final CMT and VA and were compared to the baseline values - ANOVA analysis was used for significance.If patients had laser or vitrectomy done, only data points before the procedure was used for analyses. Patients with other macular diseases were also excluded.
Although 49 eyes of 28 patients initially met the inclusion criteria, data for only 28 eyes of 18 patients were analyzed finally after exclusion criteria. The mean number of injections required in treatment of DME were 6.6 over a mean period of 2.5 years follow-up. Mean CMT and VA at baseline were 352.5µ and 0.34 - final values were 314.2µ and 0.28. Improvement in OCT and VA was statistically significant till 6 injections – after that it showed a plateau-effect.
Intravitreal bevacizumab is effective for improvement of VA and CMT in DME – however, this effect tends to decrease with increasing number of injections after that - six injections in this study. In the future, studies can be done to investigate switching these patients with persistent DME to a different anti-VEGF agent after 6 injections of bevacizumab.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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