Therapeutic Effects of Intravitreal Bevacizumab Injection for Retinal Neovascularization Secondary to Proliferative Diabetic Retinopathy

June Kyu Chang; Moo Hwan Chang

doi:10.3341/jkos.2009.50.9.1359

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Chang and Chang: Therapeutic Effects of Intravitreal Bevacizumab Injection for Retinal Neovascularization Secondary to Proliferative Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2009;50(9):1359-1370.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.9.1359

Therapeutic Effects of Intravitreal Bevacizumab Injection for Retinal Neovascularization Secondary to Proliferative Diabetic Retinopathy

June Kyu Chang, MD, Moo Hwan Chang, MD

Department of Ophthalmology, Dankook University College of medicine, Cheonan, Korea

Address reprint requests to Moo Hwan Chang, MD Department of Ophthalmology, Dankook University College of medicine #San 16-5 Anseo-dong, Cheonan, Chungnam 330-715, Korea Tel: 82-41-550-6377, Fax: 82-41-561-0137, E-mail: changmh@dankook.ac.kr

Received 21 January 2009 Accepted 26 May 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the short-term effects of a single intravitreal injection of bevacizumab (Avastin) for the management of new vessels (NV) associated with proliferative diabetic retinopathy (PDR).

Methods

A non-randomized study of 19 PDR patients (20 eyes) who had active NV was analyzed prospectively. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 4, and 8 after intravitreal injection of 1.25 mg of bevacizumab. The main outcome measures included changes in total area of fluorescein leakage from active NV and best corrected visual acuity (BCVA).

Results

Twenty eyes of 19 patients (12 men [63.2%], 7 women [36.8%]) were included and all patients completed the 8-week study followup period. The mean age of participants was 47.05±12.48 years. At baseline, NV area was 23.02±21.80 mm². The area of active NV decreased significantly to 4.96±9.18 mm², 1.11±4.96 mm² and 4.55±5.11 mm² (p<0.05) at 1, 4 and 8 weeks after injection, respectively. At week 4, no leakage was observed in 19 eyes. The mean logMAR BCVA improved from 0.59±0.49 at baseline to 0.56±0.47, 0.55±0.73 and 0.51±0.50 at weeks 1, 4, and 8, respectively. No significant adverse events were observed.

Conclusions

Short-term results suggest that intravitreal injection of bevacizumab is associated with a rapid regression of retinal neovascularization secondary to PDR.

Keywords: Intravitreal Bevacizumab, Proliferative diabetic retinopathy

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Figure 1.

Setting dimensions of the optic disc. A and B, Measurement of optic disc transverse length (red line). C and D, Measurement of optic disc vertical length (red line).

Figure 2.

Setting extension of new vessels. Red free photographs from diabetic patient with active new vessels taken at baseline (A), and at 8 week (B) after intravitreal bevacizumab injection.

Figure 3.

Setting extension (yellow line) and pixels (red line) of optic disc (A) and new vessel (B, C) by using Adobe^® Photoshop^® 8.0.

Figure 4.

Best corrected visual acuity (logarithm of the minimum angle of resolution values) after intravitreal bevacizumab injection.

Figure 5.

Total area of active new vessels (mm²) after intravitreal bevacizumab injection.

Figure 6.

Color fundus photographs from diabetic patient (case 1) with active new vessels at the disc (NVD) taken at baseline (A), and at 1 week (B), 4 week (C), 8 week (D) after intravitreal bevacizumab injection. Remarkable regression of NVD observed at baseline is seen at week 1, 4, 8 week after one single intravitreal injection of 1.25 mg of bevacizumab.

Figure 7.

Color fundus photographs, red free, early- and late-phase fluorescein angiographs from a diabetic patient (case 2) with active new vessels and fibrovascular proliferation. Leaking new vessels and fibrovascular proliferation was seen at baseline (A). Some staining but no fluorescein leakage from new vessels noted at baseline could be seen at 4 week after an intravitreal injection of 1.25 mg of bevacizumab (B). 8 week after injection minimal fluorescein leakage is observed from new vessels noted at baseline (C).

Figure 8.

Color fundus photographs, red free, early- and late-phase fluorescein angiographs from a diabetic patient (case 4) with active new vessels. Actively leaking new vessels was seen at baseline (A). Some staining but no fluorescein leakage from new vessels noted at baseline could be seen at 4 week after an intravitreal injection of 1.25 mg of bevacizumab (B).

Figure 9.

Color fundus photographs, red free, early-, mid- and late-phase fluorescein angiographs from a diabetic patient (case 8) with active new vessels. Active areas of neovascularization elsewhere was seen at baseline (A). Complete resolution of the fluorescein leakage from new vessels noted at baseline could be seen at 4 week after an intravitreal injection of 1.25 mg of bevacizumab (B).

Figure 10.

Color fundus photographs from diabetic patient (case 15) with active new vessels at disc (NVD), dense fibrovascular tissue taken at baseline (A), and at 1 week (B), 4 week (C) after intravitreal bevacizumab injection. Regression of NVD observed at baseline is seen at week 1. But 4 week after intravitreal injection, the development of tractional retinal detachment (TRD) was observed and underwent vitrectomy. After surgery, NVD and dense fibrovascular tissue was completely removed (D).

Table 1.

Clinical charateristics, total area of active new vessel (mm²) and best corrected visual acuity (logMAR^§) at baseline and during the 8-week study period

Case	Sex	Age	DM^∗ Type	DM Duration	Baseline		Week 1		Week 4		Week 8
Case	Sex	Age	DM^∗ Type	DM Duration	NV^† area	BCVA^‡	NV area	BCVA	NV area	BCVA	NV area	BCVA
1	M	59	II	19	2.21	0.52	0	0.22	0	0.30	0	0.52
2	M	63	II	11	12.30	0.40	0	0.4	0	0.30	3.75	0.22
3	M	40	II	10	13.31	1.30	0	1.10	0	1.10	0.95	1.30
4	M	40	II	10	6.94	0.40	0	0.40	0	0.30	4.89	0.30
5	M	49	II	12	10.57	0.30	3.01	0.30	0	0.22	4.59	0.40
6	F	51	II	13	63.89	1.70	10.44	1.70	0	1.70	16.77	1.70
7	F	36	II	9	34.56	0.00	8.83	0.22	0	0.00	4.41	0.04
8	F	63	II	16	26.01	0.30	0	0.30	0	0.22	7.89	0.30
9	M	31	I	18	9.73	0.52	0	0.52	0	0.40	0	0.40
10	M	29	I	16	6.33	0.10	0	0.04	0	0.10	1.30	0.10
11	M	30	I	18	59.20	0.30	8.85	0.30	0	0.40	13.54	0.40
12	M	47	II	23	81.36	1.30	40.41	1.30	0	1.30	15.13	1.30
13	F	52	II	12	14.14	0.10	0	0.22	0	0.10	6.67	0.00
14	F	35	I	19	10.17	1.40	2.33	1.30	0	0.52	2.08	0.52
15	M	61	II	15	35.63	1.10	8.99	1.15	22.21	3.00	0	1.40
16	M	36	I	21	17.49	0.70	5.71	0.52	0	0.40	4.09	0.52
17	M	48	II	10	21.05	0.22	3.02	0.10	0	0.10	1.04	0.10
18	F	70	II	45	22.66	0.15	7.67	0.15	0	0.10	1.79	0.22
19	F	41	II	3	4.09	0.50	0	0.50	0	0.00	0	0.00
20	M	53	I	30	8.77	0.50	0	0.50	0	0.50	2.05	0.50

^∗ DM=Diabetes mellitus;

^† NV=New Vessel;

^‡ BCVA=best corrected visual acuity;

^§ logMAR=logarithm of minimum angle of resolution.

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