Intravitreal bevacizumab for diabetic macular edema associated with severe capillary loss: one-year results of a pilot study

Marco Bonini-Filho, Rogério A Costa, Daniela Calucci, Rodrigo Jorge, Luiz A S Melo, Ingrid U Scott
American Journal of Ophthalmology 2009, 147 (6): 1022-30, 1030.e1-5

PURPOSE: To evaluate the effects of intravitreal bevacizumab in patients with diabetic macular edema (DME) associated with severe capillary loss.

DESIGN: Multicenter, open-label, nonrandomized study.


SETTING: Two tertiary ophthalmic referral centers in Brazil.

STUDY POPULATION: Ten consecutive patients with DME and "severe" capillary loss.

OBSERVATION PROCEDURES: Intravitreal injection(s) of bevacizumab (1.5 mg). Standardized ophthalmic evaluation was performed at baseline and at weeks 8, 16, 24, and 54.

MAIN OUTCOME MEASURES: Changes in best-corrected visual acuity (BCVA) and in optical coherence tomography variables (central macular thickness [CMT] and total macular volume [TMV]).

RESULTS: Significant changes in BCVA and in CMT/TMV were noted throughout the study (P < .001, P = .009, and P < .001, respectively). The mean logarithm of the minimal angle of resolution Early Treatment Diabetic Retinopathy Study BCVA was 0.786 ( approximately 20/125(+1)) at baseline, 0.646 ( approximately 20/80(-2)) at week 8, 0.580 (20/80(+1)) at week 16, 0.574 ( approximately 20/80(+1)) at week 24, and 0.558 ( approximately 20/80(+2)) at week 54. Compared with baseline, a significant change in BCVA was noted at all follow-up visits (P <or= .008). The mean CMT/TMV values were, respectively, 472.6/10.9 at baseline, 371.4/9.9 at week 8, 359.5/9.8 at week 16, 323.9/9.4 at week 24, and 274.6/8.7 at week 54. Compared with baseline, a significant change in both CMT and TMV was noted only at 24 and 54 weeks (P <or= .007). At 54 weeks, fluorescein angiography demonstrated no change in the extent of macular capillary loss and reduced dye leakage as compared with baseline in all patients.

CONCLUSIONS: Favorable changes in BCVA and in CMT/TMV observed throughout 1 year suggest that intravitreal bevacizumab may be a viable alternative treatment for the management of patients with DME and severe capillary loss.

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