Long-Term Results of Intravitreal Bevacizumab Injection for Macular Edema : Retinal Vein Obstruction and Diabetic Retinopathy

Seung Won Lee; Moo Sang Kim; Eung Suk Kim; Hyung Woo Kwak; Seung Young Yu

doi:10.3341/jkos.2009.50.2.211

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Lee, Kim, Kim, Kwak, and Yu: Long-Term Results of Intravitreal Bevacizumab Injection for Macular Edema : Retinal Vein Obstruction and Diabetic Retinopathy

Original Article

J Korean Ophthalmol Soc 2009;50(2):211-218.

Published online: 3 January 2009

DOI: https://doi.org/10.3341/jkos.2009.50.2.211

Long-Term Results of Intravitreal Bevacizumab Injection for Macular Edema : Retinal Vein Obstruction and Diabetic Retinopathy

Seung Won Lee, MD, Moo Sang Kim, MD, Eung Suk Kim, MD, Hyung Woo Kwak, MD, Seung Young Yu, MD

Department of Ophthalmology, KyungHee University College of Medicine, Seoul, Korea

Address reprint requests to Seung Young Yu, MD. Department of Ophthalmology, KyungHee University College of Medicine #1 Hoegi-dong, Tongdaemun-gu, Seoul 130-702, Korea Tel: 82-2-958-8451, Fax: 82-2-966-7340, E-mail: syyu@khu.ac.kr

Received 10 June 2008 Accepted 11 September 2008

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 long-term results of intravitreal bevacizumab injection for macular edema (ME) due to retinal vein obstruction (RVO) and diabetic retinopathy (DR).

Methods

The objects of study were patients with decreased visual acuity due to ME with RVO and DR for whom intravitreal injections of 1.25 mg (0.05 ml) bevacizumab were repeated three times with an interval of six weeks and who were available for a follow-up period of more than 12 months. The patients underwent additional bevacizumab injections if ME increased as assessed by optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and follow-up visits.

Results

There were 16 patients with RVO and 18 patients with DR. In the RVO group, the mean length of follow-up was 12.4±1.1 months, the mean baseline BCVA was 0.75±0.32 and the final BCVA was 0.42±0.25, a difference that was statistically significant (p＜0.05). The mean CMT at baseline was 588.5±301.0 µm and this decreased to a mean of 191.8±112.0 µm at the end of the follow-up period (p＜0.05). In the DR group, the mean length of follow-up was 15.4±3.2 months, the mean baseline BCVA was 0.63±0.33 and the final BCVA was 0.61±0.37, a difference that was not statistically significant (p＞0.05). The mean CMT at baseline was 462.0±195.0 µm and decreased to a mean of 282.2±177.3 µm at the end of the follow-up period (p＜0.05).

Conclusions

In RVO and DR, three injections of intravitreal bevacizumab with an interval of six weeks and additional injections as indicated were effective in reducing ME and showed especially good results in improvement of visual acuity for ME due to RVO.

Keywords: 12 month follow-up, Bevacizumab, Diabetic retinopathy, Macular edema, Retinal vein occlusion

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Figure 1.

Changes in best-corrected visual acuity (BCVA, logMAR) after intravitreal bevacizumab. RVO (retinal vein occlusion) group shows general improvement of visual acuity after 1 ^st, 2 ^nd injection of bevacizumab, and visual acuity seems to be maintained from the time of the 3 ^rd injection to 12 months after injection. The mean baseline BCVA was 0.75±0.32 and the final BCVA was 0.42±0.25, a difference that was statistically significant (p<0.05). DR (diabetic retinopathy) group also shows improvement of visual acuity after injection of bevacizumab but the degree is small and visual acuity appears to decrease from 18 weeks after injection. The mean baseline BCVA was 0.63±0.33 and the final BCVA was 0.61±0.37, a difference that was not statistically significant (p>0.05).

Figure 2.

Final best-corrected visual acuity (BCVA) analysis after intravitreal bevacizumab. RVO (retinal vein occlusion) group demonstrated that 10(62.5%) eyes improved ≥ 2 lines of BCVA, 5(31.3%) eyes remained stable, 1(6.3%) eye decreased ≥ 2 lines of BCVA with Snellen chart. DR (diabetic retinopathy) group demonstrated that 5(27.8%) eyes improved ≥2 lines of BCVA, 6(33.3%) eyes remained stable, 7(38.8%) eyes decreased ≥ 2 lines of BCVA with Snellen chart.

Figure 3.

Changes in central macular thickness after intravitreal bevacizumab. RVO (retinal vein occlusion) groupshows general decrease of macular edema after injection of bevacizumab and seems to be maintained from the time of the 3rd injection to 12 months after injection. DR (diabetic retinopathy) group also shows improvement of macular edema after injection of Bevacizumab but the degree is small than RVO group. Both RVO and DR groups showed statistically significant decrease of macular thickness than baseline (RVO: 588.5±301.0 µm 191.8±112.0 µm, DR: 462.0±195.0 µm 282.2±177.3 µm, p<0.05).

Figure 4.

Number of intravitreal bevacizumab injections in retinal vein occlusion and diabetic retinopathy for 12-month follow-up.

Table 1.

Demographics of patients

	RVO^* (n=16)	DR^† (n=18)
Age (years)	59.73±12.13	58.86±8.68
Gender (female/male)	9/7	9/9
Mean follow-up (months)	12.4±1.1	15.4±3.2
Visual acuity (logMAR)	0.75±0.32	0.63±0.33
Central macular thickness(μm)	588.5±301.0	462.0±195.0

^* RVO=retinal vein occlusion;

^† DR=diabetes retinopathy.

Table 2.

Ocular complications following intravitrea bevacizumab

Complications
Subconjunctival hemorrhage	5 (14.3%)
IOP change	0
Endophthalmitis	0
Tractional retinal detachment	0
Rhegmatogenous retinal detachment	0
Vitreous hemorrhage	2 (6.0%)
Uveitis	0

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