EFFECTS OF UNILATERAL INTRAVITREAL BEVACIZUMAB ON THE CONTRALATERAL EYE HAVING DIABETIC MACULAR EDEMA

Objective: To investigate the effect of unilateral intravitreal Bevacizumab on contralateral eye in bilateral diabetic macular edema. Study Design: Quasi-experimental study. Place and Duration of Study: Retina Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from Sep to Dec 2020. Methodology: Thirty-two patients were enrolled with consecutive sampling. All the patients had clinically diagnosed diabetic macular edema having >275µm macular thickness on OCT. They were injected with 1.25mg/0.05mL of Bevacizumab in one eye. Baseline macular thickness was compared with 4 weeks follow up macular thickness, using Optical Coherence Tomography. Results: The central macular thickness in the untreated eye at baseline was 396.97 ± 29.79 µm and 388.34 ± 30.06 µm at 4 weeks (p-value=0.001). The difference in central macular thickness in treated and untreated eyes were 28.44 ± 4.11 µm and 19.81 ± 5.31 µm respectively (p-value = 0.001). There were statistically significant differences between these measurements. Conclusion: Injecting Bevacizumab in one eye for diabetic macular edema has statistically significant effect on the contralateral non-injected eye macular thickness.

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

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.

Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with 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.

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

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.