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Anatomical and visual outcome of intravitreal bevacizumab (Avastin) in patients with diabetic macular edema

Shyam Vyas, Raba Thapa, Sanyam Bajimaya, Eli Pradhan, Govinda Paudyal
Nepalese Journal of Ophthalmology 2016, 8 (15): 54-61
28242886

BACKGROUND: Intravitreal bevacizumab has been shown to be an effective treatment of diabetic macular edema.

OBJECTIVE: To assess the anatomical and visual outcome of intravitrealbevacizumab (Avastin) in patients of diabetic macular edema.

MATERIALS AND METHODS: 52 eyes of 33 patients with diabetic retinopathy with CSME were included in this study. Detailed ophthalmic examination, including best-corrected visual acuity(BCVA), stereoscopic biomicroscopy, and retinal thickness measurement by Optical coherence tomography (OCT), was done at baseline and at each follow- up visit. All patients were treated with 0.05 mL intravitreal injection containing 1.25 mg of bevacizumab and repeat injection was given in cases of recurrent/persistent subretinal or intraretinal fluid shown by OCT and deterioration of BCVA.

RESULTS: All patients completed 6 months of follow-up with mean number of 2.78 intravitreal injections per eye.The mean BCVA at baseline was 0.80 log MAR, with significant changes 0.68 (p=0.012), 0.63 (p=less than0.001) and 0.60 log MAR (p=less than0.001) at 6 weeks, 3 months, and 6 months respectively. Final BCVA analysis demonstrated that 25 eyes (48.07%) remained stable and 22 (42.30%) improved ≥2 lines on BCVA. The mean central retinal thickness was 449.03 μm at baseline and it decreased significantly to 410.09 (pless than0.001),345.76(p less than 0.001), 344.55(p less than 0.001) and 326.51(p less than 0.001) at 1st day, 6 weeks, 3 months and 6 months post injection, respectively. Mean macular volume changed significantly from baseline of 10.77 μm to 10.33μm (p less than 0.001) 8.97 (p less than 0.001), 8.82 (p less than 0.001), 8.95 (p less than 0.001) at 1st day, 6 weeks, 3 months and 6 months post injection respectively.

CONCLUSION: Intravitreal bevacizumab injection resulted in significant improvement in BCVA, central retinal thickness and total macular volume in patients with diabetic retinopathy with CSME, and this beneficial effect is maximum at 6 weeks. Also, slight reduction in these parameters at 3 month follow up suggests that visual improvement and stable macular thickness can be maintained longer with injection frequency of probably 6-12 weeks.

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