Journal List > J Korean Ophthalmol Soc > v.51(5) > 1008812

Jeong, Kim, Moon, Lee, and Cho: The Effects of Intravitreal Bevacizumab Injection According to the Type of Diabetic Macular Edema

Abstract

Purpose

To investigate the effects of intravitreal bevacizumab injection on diabetic macular edema (DME) of different types classified using Optical Coherence Tomography (OCT).

Methods

A total of 82 eyes with refractory DME were enrolled. The DME was classified into diffuse, cystoid, or serous type based on the OCT findings. All cases had received an intravitreal injection of 1.25 mg bevacizumab each month for three months. Foveal thickness, macular volume, and best corrected visual acuity (BCVA) were measured before and one month after the injection, and the interval changes in these parameters were compared.

Results

The types of DME were classified as follows: diffuse macular edema 50%, cystoid macular edema 31.7%, and serous macular detachment 18.3%. Foveal thickness and total macular volume after intravitreal bevacizumab injection decreased in all types, and the cystoid and serous types showed better response than did the diffuse type with regard to foveal thickness. However, there were no significant differences in the extent of the change in total macular volume or BCVA among the three types of DME.

Conclusions

There were differences in the therapeutic effects of intravitreal bevacizumab injection among the different types of DME classified using OCT. These differences may be associated with the stabilizing effect of the bevacizumab. This effect was stronger with regard to vascular permeability, the primary factor in the pathogenesis of the cystic and serous types, than with regard to leakage from the microaneurysm, the primary factor in the pathogenesis of the diffuse type. Practical application of bevacizumab to eyes with different DME types will help in further evaluating intravitreal bevacizumab injection as a treatment option for DME.

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Figure 1.
An analysis of the foveal thickness before and 1 month after the third intravitreal bevacizumab injection. Foveal thickness significantly decreased in every type (Wilcoxon's signed rank test, p=.02, p<.001, p=.001, with p<.05 regarded as significant). And the extent of changes in types of cystoid macular edema and serous macular detachment was greater than in diffuse macular edema type (Mann-Whitney U test p=.002, with p<.05 regarded as significant).
jkos-51-700f1.tif
Figure 2.
An analysis of total macular volume before and 1 month after the third intravitreal bevacizumab injection. Total macular volume was significantly decreased in every type (Wilcoxon's signed rank test, p=.01, p= .001, p=.02, with p<.05 regarded as significant). But there were no significant differences for the extent of changes among the three types of diabetic macular edema (Mann-Whitney U test p>.05, with p<.05 regarded as significant).
jkos-51-700f2.tif
Figure 3.
An analysis of the best corrected visual acuity (BCVA) before and 1 month after the third intravitreal bevacizumab injection. There were neither significant differences for changes of BCVA in the three types of macular edema nor for the extent of changes among the three types of diabetic macular edema (Wilcoxon's signed rank test p>.05, Mann-Whitney U test p>.05, with p<.05 regarded as significant).
jkos-51-700f3.tif
Table 1.
Baseline characteristics of eyes with different types of OCT findings (Mean± standard deviation)
  Diffuse Cystoid Serous detachment
Number of eyes (%) 41 (50) 26 (31.7) 15 (18.3)
Age (years) 62.8±13.2 64.6±9.1 58.9±14.0
Male: Female (eyes) 24: 17 18: 8 8: 7
DM duration (years) 17.8±8.9 14.2±7.5 11.1±6.2*
HbA1c (%) 7.1±1.1 8.2±2.2* 7.4±1.6
Foveal thickness (μm) 276.9±60.9* 341.3±112.9* 368.6±151.9*
Total macular volume (mm3) 7.96±0.80 8.16±1.72 8.93±2.68*
BCVA (LogMAR) 0.40±0.46* 0.51±0.38* 0.49±0.28*

* Kruskal-Wallis test: p<0.05

BCVA=best corrected visual acuity.

Table 2.
Changes of main parameters in total subjects after intravitreal bevacizumab injection (Mean± standard deviation)
  Pre injection Post* injection p-value
Foveal thickness (μm) 314.3±105.9 273.7±85.5 <0.001
Total macular volume (mm3) 8.20±1.61 7.79±1.10 <0.001
BCVA (LogMAR) 0.45±0.40 0.41±0.38 0.053

* One month after the third injection

Wilcoxon signed ranks test

BCVA=best corrected visual acuity.

Table 3.
Correlation of outcome parameter changes with risk factors of diabetic macular edema. P values were analyzed using bivariate correlation (r=Pearson correlation coefficient)
OCT types   Foveal thickness Total macular volume BCVA*
Total DM duration .195 .568 .465
  HbA1c .352 .494 .321
Diffuse DM duration .543 .846 .671
  HbA1c .043 (r=0.325) .014 (r=0.392) .306
Cystoid DM duration .965 .956 .487
  HbA1c .820 .766 .600
Serous detahcment DM duration .364 .738 .462
  HbA1c .631 .367 .606

* BCVA=best corrected visual acuity.

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