Correlation of response to intravitreal bevacizumab treatment between the first and second treated eyes in diabetic macular edema

2021 ◽  
pp. 112067212110596
Author(s):  
Nadav Levinger ◽  
Liran Tiosano ◽  
Elishai Assayag ◽  
Rivkah Lender ◽  
Tomer Batash ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Thickness Reduction ◽  
Bevacizumab Treatment ◽  
Central Subfield Thickness ◽  
Bilateral Diabetic Macular Edema ◽  
The Mean ◽  
Selection Of

Purpose To evaluate whether outcome of bevacizumab treatment in the first treated eye can guide the selection of compound for the second treated eye in patients with bilateral diabetic macular edema. Methods Demographic, clinical, and optical coherence tomography data were retrospectively collected from consecutive patients who underwent bevacizumab therapy for bilateral diabetic macular edema. Change in central subfield thickness and visual acuity were evaluated and compared between the first treated eye and second treated eye. Results A total of 66 eyes of 33 patients were included in the study. The mean ± SD follow-up time was 13 ± 5 months. The mean ± SD central subfield thickness at baseline was 464 ± 30 μm in the first treated eye and 461 ± 29 μm in the second treated eye ( p = 0.91). Final central subfield thickness was reduced to 392 ± 27 μm in the first treated eye ( p = 0.01 compared with baseline) and 416 ± 25 μm in the second treated eye ( p = 0.03 compared with baseline). Using ≥5% or ≥10% reduction of central subfield thickness as diagnostic criteria to predict similar magnitude of thickness reduction in the first treated eye yielded a positive and negative predictive value ranging from 46% to 81%, and sensitivity and specificity ranging from 54% to 84%. Regression models did not show correlation between central subfield thickness reduction in first treated eye and the second treated eye at the end of follow-up. Conclusions Bevacizumab therapy reduced macular thickness in both eyes in bilateral diabetic macular edema. Treatment outcome of the first treated eye could not predict the outcome of the second treated eye. Particularly, failure to reduce central subfield thickness in the first treated eye does not preclude a favorable response to bevacizumab therapy in the second eye.

scholarly journals Evaluation of the Response to Ranibizumab Therapy following Bevacizumab Treatment Failure in Eyes with Diabetic Macular Edema

2015 ◽  
Vol 6 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Joel Hanhart ◽  
Itay Chowers
Keyword(s):  
Treatment Failure ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Median Number ◽  
Vascular Endothelial ◽  
Spectral Domain Oct ◽  
Bevacizumab Treatment ◽  
Central Subfield Thickness ◽  
The Mean ◽  
Endothelial Growth Factor

Background/Aims: Bevacizumab and ranibizumab are routinely used to treat diabetic macular edema (DME). We aim to evaluate the usefulness of switching to ranibizumab therapy following bevacizumab treatment failure in eyes with DME. Methods: We performed a retrospective analysis of a consecutive group of patients with DME who received ranibizumab injections following the failure of bevacizumab injections. The injections were delivered following a pro re nata protocol every 4-6 weeks. The data collected included demographics, systemic and ophthalmic findings, as well as the central subfield thickness according to spectral-domain OCT. Results: Eight eyes (5 patients) were included in the study. The median number of bevacizumab injections prior to the switch to ranibizumab was 4, and the median number of ranibizumab injections during the study was 2. The mean follow-up period was 541 ± 258 days. The mean central retinal thickness (CRT) (±SEM) was 539 ± 75 μm before the initiation of bevacizumab treatment, and 524 ± 43 μm after the last bevacizumab injection (p = 0.7). It reduced to 325 ± 26 μm following the ranibizumab injections (p = 0.0063). The best-corrected visual acuity (BCVA) improved in 4 eyes and remained stable in 4 eyes following the ranibizumab injections. Conclusion: A ranibizumab therapy was effective in reducing the CRT in eyes that failed bevacizumab therapy. A BCVA improvement can also occur in these eyes. Switching between anti-vascular endothelial growth factor compounds may be beneficial in eyes with DME.

Ranibizumab for Persistent Diabetic Macular Edema after Bevacizumab Treatment

2016 ◽  
Vol 27 (2) ◽  
pp. 210-214 ◽  
Author(s):  
Gabriel Katz ◽  
Elad Moisseiev ◽  
Dafna Goldenberg ◽  
Joseph Moisseiev ◽  
Yosef Lomnicky ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Significant Gain ◽  
Bevacizumab Treatment ◽  
The Mean ◽  
The Difference ◽  
Persistent Diabetic Macular Edema

Purpose To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Methods This was a retrospective study of patients with DME initially treated with bevacizumab and switched to ranibizumab. Visual acuity (VA) and central retinal thickness (CRT) were retrieved at fixed timepoints prior to and after the switch. Results Forty eyes of 32 patients were included in the study. The difference in VA between any of these fixed timepoints was not statistically significant. A significant gain in VA was found in eyes that lost more than 0.1 logMAR during treatment with the last 3 bevacizumab injections. The mean CRT was significantly lower after the first 3 ranibizumab injections and at the final follow-up (p<0.001), a 67 ± 14 μm and 78 ± 18 μm reduction in thickness, respectively. Conclusions Switching to ranibizumab resulted in a significant decrease in the CRT of eyes with DME, and should be considered when there is a lack of response or deterioration while on bevacizumab injections. A significant gain in VA was observed in a subgroup of eyes that lost more than one line while receiving the last 3 bevacizumab injections prior to the switch.

scholarly journals A Prospective Study of Safety Profile and Efficacy of three doses of Intravitreal Bevacizumab in Diabetic Macular Edema

2021 ◽  
Vol 4 (2) ◽  
pp. 127
Author(s):  
Nasrin Y ◽  
Sharma Ajay ◽  
Sharmila Yalakala
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Therapeutic Agent ◽  
Intravitreal Bevacizumab ◽  
Systemic Complications ◽  
Systemic Side Effects ◽  
The Mean ◽  
A Prospective Study

Introduction: Current study aimed to evaluate efficacy of intravitreal Bevacizumab in Diabetic macular edema, and to identify their ocular and systemic complications if any. Method: It is a prospective, interventional study with 68 patients in 82 eyes with Diabetic macular edema. All treated by 3 injection of intravitreal bevacizumab with 1 month interval. Visual acuity, macular edema, and complications evaluated at every month upto 6th months. Ranibizumab was offered if the patient is a non-respondent to Bevacizumab. Results: Majority age group of 61-70 years with a mean age of 59 ± 6.72 years. The mean duration of diabetes was 11.68 ± 7.2 years. The mean baseline BCVA and CRT are 0.64 ± 0.28 Log MAR units and 436.99 ± 135.10 μm. After 3 injections, BCVA values are 0.48±0.27 (p< 0.01)), 0.36±0.24 (p<0.01)), and 0.27±0.24 (p<0.01), 0.23±0.27 Log MAR (p<0.01)) at 1month, 2 months, and 3 months, and 6 months follow-up respectively. CMT levels are 315.79±124.60 μ at 1 month, after 3rd IVA and this significant change (p<0.01) followed with subsequent follow-up with mean CRT of 296.04±122.97 μ (p< 0.01) at 6th month. The BCVA improved ≥ 2 Snellen lines in 69.5% and 78% cases, resolution of CMT in 56% and 69.5% cases at 3 months and 6 months respectively. At the end of the 3rd month, 46 eyes macular edema completely resolved with 3 injections of IVA, 23 eyes persistent macular edema present, 13 eyes refractory to bevacizumab injections. Persistent & Refractory macular edema eyes (36) switched to Ranibizumab injections.In persistent macular edema, significant resolution (p≤0.01) of macular thickness (370.52 ± 71.43 µm vs. 341.08 ± 122.75 µm) without (p=0.09) improvement in visual acuity (0.45 ± 0.20 vs. 0.34 ± 0.23) was observed post Ranibizumab injections.  In Refractory macular edema, thickness of cases no significant (497.76 ± 161.07µm vs 407.84 ± 169.64 µm) improvement seen after Ranibizumab injections(p=0.1). Recurrence of macular edema seen in 10.9%. Subconjunctival haemorrhage seen in 10.9%-12.1% cases, raised IOP in 2.4%-3.6% cases at post injection day 1. No other ocular and systemic complications were observed during follow-up. Conclusions: Intravitreal bevacizumab is effective in treatment of diabetic macular edema but therapeutic effect is temporary and repeat treatment is needed. It does not show any potential drug related ocular and systemic side effects, hence it is safe and economical therapeutic agent

Comparative Eye Effect of Unilateral Intravitreal Bevacizumab, Ranibizumab, and Aflibercept for Diabetic Macular Edema

2019 ◽  
Vol 3 (2) ◽  
pp. 86-89
Author(s):  
Brett Malbin ◽  
Harshad P. Patel ◽  
Yuguang He ◽  
Kim Le ◽  
Xihui Lin
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Fellow Eye ◽  
Anti Vegf ◽  
Central Subfield Thickness ◽  
Bilateral Diabetic Macular Edema ◽  
Pharmacologic Treatments ◽  
Endothelial Growth Factor ◽  
Significant Therapeutic Effect

Purpose: The purpose of this article is to compare the fellow-eye effect of unilateral intravitreal antivascular endothelial growth factor (anti-VEGF) treatment (bevacizumab, ranibizumab, and aflibercept) in patients with bilateral diabetic macular edema (DME). Methods: A retrospective review was conducted of hemoglobin A1c-matched groups receiving unilateral anti-VEGF injections (1.25 mg bevacizumab, 0.5 mg ranibizumab, and 2 mg aflibercept) in which the second eye had subclinical DME. Two main outcome measures evaluated were central subfield thickness (CST) on optical coherence tomography and best-corrected visual acuity (BCVA). Patients were excluded if they had poor BCVA (< 20/100) or had received laser, vitrectomy, filtering surgery, or pharmacologic treatments in the 3 months prior in the noninjected eye. Results: A total of 2073 total intravitreal anti-VEGF injections for DME were reviewed and 94 met the inclusion criteria: 40 bevacizumab, 33 ranibizumab, and 21 aflibercept. At 1 month, the CST of the fellow eye in the bevacizumab group had a statistically significant decrease (296.82 µm to 292.46 µm, P = .01) while both the ranibizumab and aflibercept groups trended toward worsening edema. When compared to ranibizumab and aflibercept, the CST in the noninjected eye in the bevacizumab group had improvements of –15.03 µm and –13.47 µm, respectively ( P < .019). When bevacizumab was switched to ranibizumab or aflibercept, the edema in the fellow eye worsened by +49.60 µm and +5.50 µm, respectively. Conclusion: Bevacizumab injection has a statistically significant therapeutic effect in the fellow eye when compared to those treated with ranibizumab and aflibercept. The edema in the fellow eye worsened when injection in the primary eye was switched away from bevacizumab.

scholarly journals Evaluation of Ellipsoid Zone Changes in Different Types of Diabetic Macular Edema After Intravitreal Bevacizumab Injection

2021 ◽  
Author(s):  
Utku Limon ◽  
Betul Ilkay Sezgin Akcay
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Inclusion Criteria ◽  
Ellipsoid Zone ◽  
Intravitreal Bevacizumab Injection ◽  
Group 4 ◽  
The Mean ◽  
Bevacizumab Injection

Abstract Purpose: To evaluate the ellipsoid zone (EZ) changes according to the types of diabetic macular edema (DME) on optical coherence tomography (OCT) after intravitreal bevacizumab injection. Methods: In this retrospective study, medical records of the patients who had treatment-naive DME and underwent intravitreal bevacizumab treatment between January 2015 and December 2021 were analyzed. Patients who meet the inclusion criteria and completed the follow-up period of 12 months were divided into 4 groups according to the types of diabetic macular edema on OCT (Diffuse DME [Group-1], cystoid DME [Group-2], diffuse DME with serous retinal detachment (SRD) [Group-3] and cystoid DME with SRD [Group-4]). Primary outcomes were EZ changes between the groups.Results: 125 eyes of 96 patients who fulfilled the inclusion criteria and completed the follow-up period were included in the study. There were no statistically significant differences in EZ improvements between the groups at 4, 6 and 12 months after treatment (p =0,594, p=0,836, p=0,486, p=0,748 respectively). The mean logMAR BCVA and CMT of all eyes showed significant improvement at 4, 6 and 12 months. When the mean CMT was compared between each groups, there were significant differences between the Group-1and Group-4 at 4, 6 and 12 months after treatment. (p<0,05)Conclusion: The BCVA gains and improvement in the CMT were maintained in all four DME types during the first year of intravitreal bevacizumab therapy. The improvement in EZ disruption was not depent on the type of DME and improved similarly in all groups.

Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with bilateral diabetic macular edema

2020 ◽  
Vol 1 (3) ◽  
pp. 183-189
Author(s):  
Sever Ozkan ◽  
◽  
Celik Erkan ◽  
Topcu Birol ◽  
◽  
...  
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Randomized Study ◽  
Intravitreal Bevacizumab ◽  
Diabetic Patients ◽  
Steroid Dependent ◽  
Bilateral Diabetic Macular Edema

AIM: To Compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema. METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab (IVB group) was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide (IVTA-IVB group) was performed. Main outcomes were the central macular thickness (CMT) measured with optical coherence tomography (OCT), ETDRS visual acuity (VA) and intraocular pressure (IOP). RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 µm and 546.8±165.6 µm before injections; 430.4±133.2 µm and 363.7±105.3 µm at first month; 484.8±167.4 µm and 407.3±108.7 µm at 3rd month; 550.4±191.5 µm and 516.8±158 µm after 6mo respectively. Differences were significant at first and 3rd month (P?0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 at first month; 59±13.7 and 59.3±13.6 at 3rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant at first and 3rd and 6mo (P?0.05). There was no IOP difference. IVTA-IVB group gains best VA at 3rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo. CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.

Evaluation of retinal inflammatory biomarkers after intravitreal steroid implant and Ranibizumab injection in diabetic macular edema

2021 ◽  
pp. 112067212110294
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
Fatma Sümer ◽  
V Levent Karabas
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outer Nuclear Layer ◽  
Plexiform Layer ◽  
Retinal Layer ◽  
Treatment Naïve ◽  
The Mean ◽  
The Individual ◽  
Inflammatory Component

Purpose: To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. Materials and methods: Treatment naive DME eyes with subfoveal neurosensorial detachment (SND) and hyperreflective spots (HRS) were treated either three loading doses of IVR (18 eyes) or one dose of IVDEX (19 eyes). Central macular thickness (CMT), height of SND, the number of HRSs scattered on the individual retinal layers and photoreceptor integrity were assessed using spectral domain- optical coherence tomography scans over 3-months follow-up. Results: The mean change in best-corrected visual acuity (BCVA) was −0.11 ± 0.08 logMAR in IVDEX group and −0.04 ± 0.06 logMAR in IVR group at 1-month ( p = 0.011). IVDEX group showed statistically significant more increase in BCVA compared to those receiving IVR injections at 2-months ( p = 0.004) and 3-months ( p = 0.017) visits. Compared to baseline, the number of total HRSs and the number of HRSs at each individual inner retinal layer significantly decreased in both groups at all follow-up visits. However, IVDEX group showed more decrease in the total number of HRSs at 2- and 3-months ( p < 0.001 at 2-months, and p = 0.006 at 3-months) and in the mean number of HRSs located at inner nuclear layer–outer plexiform layer level ( p = 0.016 at 1-month, p < 0.001 at 2-months, and p < 0.001 at 3-months). After treatment, the number of HRSs on the outer nuclear layer showed some non-significant increase in both groups. Conclusion: HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component.

scholarly journals Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Demircan ◽  
Zeynep Alkin ◽  
Ceren Yesilkaya ◽  
Gokhan Demir ◽  
Burcu Kemer
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Medical Records ◽  
Poor Response ◽  
Intravitreal Aflibercept ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
Switch Group ◽  
Persistent Diabetic Macular Edema

Purpose. To compare the visual and anatomic outcomes in patients with persistent diabetic macular edema (DME) who switched from ranibizumab to aflibercept with those who continued with previous ranibizumab therapy. Methods. In this retrospective comparative study, medical records of consecutive patients with center-involved DME ≥ 350 μm who had at least three recent consecutive monthly ranibizumab injections followed by as-needed therapy with either aflibercept or ranibizumab were reviewed. Data were collected at presentation (preinjection), at the intermediary visit, and at the last visit (at the end of the follow-up period). Results. Forty-three eyes of 43 patients were divided into two groups: the switch group (n=20) and the ranibizumab group (n=23). Though no significant improvement was found in the mean BCVA from the intermediary visit to the last visit, there was a difference in the mean CMT in the switch group and the ranibizumab group (p<0.001 and p=0.03, resp.). The mean CMT decreased after the intermediary visit by 188.6 ± 120.5 μm in the switch group and by 60.3 ± 117.1 μm in the ranibizumab group (p=0.003). Conclusions. Both aflibercept and ranibizumab decreased CMT in patients with persistent DME who showed a poor response to ranibizumab injections. However, switching to aflibercept provided only morphologic improvement.

scholarly journals Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema

2020 ◽  
Author(s):  
Claudio Furino ◽  
Alfredo Niro ◽  
Michele Reibaldi ◽  
Maria Oliva Grassi ◽  
Francesco Boscia ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Serous Retinal Detachment ◽  
Intravitreal Dexamethasone Implant ◽  
The Mean ◽  
Group 2 ◽  
Intravitreal Dexamethasone ◽  
Pattern Group ◽  
Group 1

Purpose: Different patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD). Methods: In this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment. Results: There were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P < 0.01 and P ≤ 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, –149 ± 127 μm vs four-month CRT reduction, –72 ± 174 μm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, –0.49 ± 1.7 mm3 vs Group 2, –1.3 ± 1.3 mm3; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed. Conclusion: DEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy.

Sign in / Sign up

Export Citation Format

Share Document