Role of intravitreal bevacizumab in diabetic macular edema

Background The most frequent cause of vision loss from diabetic retinopathy is diabetic macular edema (DME). Earlier clinical trials tried to examine the role of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB) in DME; they either qualified IVT over IVB or IVB over IVT or did not exhibit a significant difference. Objective This paper aims to compare the efficacy and safety of IVB versus IVT alone or combined IVB+IVT in the treatment of DME. Methods We systematically searched PubMed, CENTRAL, Scopus, Embase, Science Direct, OVID, and Web of Science for randomized controlled trials of IVB versus IVT alone or combined IVB+IVT and IVT versus the combined IVB+IVT in DME patients. Results A total of 1243 eyes of 17 trials were included in our meta-analysis and regression. Repeated injections of IVB were superior at improving VA comparing with those of IVT at 12, 24, 48-weeks, and IVB+IVT at 12, 24, 48-weeks. Single injections were comparable across the three arms regarding BCVA improvement. CMT reductions were also comparable across the three arms. Meanwhile, the overall safety regarding intraocular pressure and intraocular hypertension significantly favored the IVB group. Improvement in VA was best modified with CMT reduction from 480 um to 320um. This association was significant at 12-weeks in the three arms and persisted till 24-weeks and 48-weeks exclusively in the IVB group. Conclusions and relevance Our analysis reveals that repeated successive injections associate with better BCVA compared to single injection. Current evidence affirms that IVB is superior to IVT and IVB+IVT at improving BCVA, comparable at reducing CMT, and presents a better safety profile in the treatment of DME.

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Analyzing the role of intravitreal bevacizumab and pars plana vitrectomy in nontractional refractory diabetic macular edema

Indian Journal of Ophthalmology ◽

10.4103/0301-4738.178147 ◽

2016 ◽

Vol 64 (1) ◽

pp. 96

Author(s):

ArvindKumar Dubey ◽

KaustubhBalwant Harshey

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Pars Plana Vitrectomy ◽

Intravitreal Bevacizumab ◽

Refractory Diabetic Macular Edema ◽

Pars Plana

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The role of structural changes in OCT in patients with diabetic macular edema

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2020-4-283-284 ◽

2020 ◽

pp. 283-284

Author(s):

S.G. Sergushev ◽

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Structural Changes

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Faculty Opinions recommendation of A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.721366009.793518421 ◽

2016 ◽

Author(s):

Michael Singer ◽

Lyndon Tyler

Keyword(s):

Randomized Controlled Trial ◽

Macular Edema ◽

Laser Therapy ◽

Diabetic Macular Edema ◽

Controlled Trial ◽

Intravitreal Bevacizumab ◽

Randomized Controlled ◽

Prospective Randomized Controlled Trial

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Current Therapy of Diabetic Macular Edema Bevacizumab, Triamcinolone Acetonide, and Laser Photocoagulation

Ophthalmologica Indonesiana ◽

10.35749/journal.v45i1.172 ◽

2019 ◽

Vol 45 (1) ◽

pp. 13

Author(s):

Gladys Kusumowidagdo ◽

Randy Sarayar ◽

Kartika Rahayu ◽

Gitalisa Andayani

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Diabetic Macular Edema ◽

Systematic Reviews ◽

Laser Photocoagulation ◽

Meta Analysis ◽

Intravitreal Bevacizumab ◽

Current Therapy ◽

Intravitreal Triamcinolone ◽

Mesh Terms

Background: Diabetic macular edema (DME) is the main cause of visual impairment in diabetic retinopathy (DR). Current gold standard therapy of DME is macular laser photocoagulation (MPC). Growing evidences have shown benefits of intravitreal anti-VEGF agents (i.e bevacizumab) and intravitreal corticosteroids (i.e triamcinolone acetonide). Aim: To compare the visual acuity (VA) improvement of patients with DME, treated with intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone (IVB/IVT), and MPC. Method: A comprehensive PubMed® and Cochrane® databases search was conducted on May 4th, 2017 using appropriate keywords (diabetic macular edema, bevacizumab, triamcinolone, and laser photocoagulation using their MeSH terms). Studies were filtered using inclusion criterions (clinical trials, RCT, meta-analysis, systematic review, English, humans, and publication within 10 years) Results: Three studies (2 systematic reviews and 1 RCT) were found suitable. From these results, all studies showed favoring effects of IVB when compared to IVB/IVT combination and MPC in short term period (up to 6 months). However, there was no significant improvement of VA beyond this period in all groups. Conclusion: IVB appears to be superior to IVB/IVT and MPC in improving VA during 6 months follow- up period. Future systematic reviews and meta-analysis are required on the effect of IVB and MPC combination in cases of DME.

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Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1051 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Muhammad Ali Haider ◽

Uzma Sattar ◽

Syeda Rushda Zaidi

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Macular Thickness ◽

Rank Test ◽

P Value ◽

Central Macular Thickness ◽

Anti Vegf ◽

Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

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