Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation

Background  To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. Methods  This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher’s Exact test, Pearson Chi-square test, independent t-test, Mann–Whitney U-test, and a repeated ANOVA. Results  The mean age of patients was 52.7 ± 12.6 years in group 1 and 53.2 ± 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 ± 7.6 weeks in group 1 and 34.1 ± 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 ± 0.30 in group 1 and 0.72 ± 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). Conclusion  ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity. The results of this study were presented at the 8th Euretina Congress 2008, Vienna, Austria. The authors have no conflicting interests in the subject matter presented.     

One-year results of combined photodynamic therapy and intravitreal bevacizumab injection for retinal pigment epithelial detachment secondary to age-related macular degeneration

Background  To evaluate the efficacy of combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in eyes with a serous pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD). Methods  Twenty-two eyes with a serous PED exceeding two disc areas associated with AMD with choroidal vascular abnormalities [choroidal neovascularization (n = 10), polypoidal choroidal vasculopathy (n = 9), and retinal angiomatous proliferation (n = 3)] received combined PDT and intravitreal bevacizumab, and were followed about every 6 weeks for more than 1 year. Additional treatments were given for residual or recurrent lesions. The main outcome measures were changes in the PED height measured by optical coherence tomography, and the best-corrected visual acuity. Results  After one treatment, the PED resolved in 12 eyes (55%) and the PED decreased in ten eyes (45%). There was no recurrence in eight (36%) eyes; however, PED recurred in 14 eyes. At 1 year, the average PED height decreased to 413 microns from the baseline 751 microns (p < 0.001). Twenty eyes (91%) had improved or stabilized vision; two eyes had decreased vision due to a retinal pigment epithelial tear and subretinal hemorrhage. Conclusions  Combined PDT and intravitreal bevacizumab may decrease the PED height and stabilize visual acuity at 1 year. The authors have no proprietary and financial interest in any aspect of this report.     

Visual and morphological outcomes of bevacizumab (Avastin<Superscript>®</Superscript>) versus ranibizumab (Lucentis<Superscript>®</Superscript>) treatment for retinal angiomatous proliferation

Retinal angiomatous proliferation (RAP) is a variant of exudative age-related macular degeneration with particularly bad prognosis. The purpose of this work is to describe the long-term functional and morphological outcome of patients treated with intravitreal bevacizumab and ranibizumab. Retrospective case series of 16 eyes treated with bevacizumab and 19 eyes treated with ranibizumab. All patients received initially three intravitreal injections of bevacizumab (1.25 mg/0.05 ml) or ranibizumab (0.5 mg/0.05 ml) every 4 weeks. Follow-up ranged from 1 to 7 months after the third injection. Complete ophthalmologic examination including best-corrected visual acuity (VA), optical coherence tomography, fluorescein angiography, and in selected cases, indocyanine green angiography was performed. Triple intravitreal injections resulted in improvement of VA in bevacizumab-treated as well as in ranibizumab-treated patients; logarithm of the minimal angle of resolution (logMAR) 0.84 before treatment and 0.67 at month 9, and logMAR 0.75 before treatment and 0.59 at month 9, respectively. Central macular thickness (CMT) in the bevacizumab group improved from 363.67 ± 47.4 μm at baseline to 328 ± 49.77 μm at month 6 (p = 0.03) and 301 ± 129.69 at month 9 (p = 0.35). CMT in the ranibizumab group improved from 545.62 ± 167.39 μm at baseline to 395.88 ± 169.37 μm at month 6 and 411.83 ± 212.41 μm at month 9 (p = 0.03, p = 0.05, respectively). Patients with RAP might benefit from both intravitreal bevacizumab and ranibizumab treatments with stabilization of VA over a longer period of time. Close follow-up should nevertheless be performed in this special subgroup because of the high recurrence rate.     

Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background  To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO). Methods  Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later. Results  Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001). Conclusions  Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.     

Pattern electroretinogram changes after intravitreal bevacizumab injection for diabetic macular edema

We aimed at investigating the efficacy of intravitreal bevacizumab injection by evaluation of pattern electroretinogram (PERG) in diabetic patients with clinically significant macular edema (CSME). Thirty-five eyes of 35 patients with diabetes were treated with 2.5 mg of intravitreal bevacizumab injection as the primary therapy for CSME. The main outcome measures included best-corrected visual acuity, fundus fluorescein angiography, and P₅₀ amplitudes of pattern electroretinogram (PERG) before and after intravitreal injection. Mean visual acuity improved significantly from a mean LogMAR value of 1.1 ± 0.2 at baseline to a maximum of 0.7 ± 0.3 after a mean follow-up time of 6.4 months. The mean baseline P₅₀ and N₉₅ amplitudes of PERG before intravitreal injection were 1.4 ± 0.7 and 2.4 ± 0.8 μV, respectively. After the treatment, the mean P₅₀ amplitude of PERG was 2.4 ± 0.9 μV at 1-month, 2.3 ± 0.8 μV at 3-month, and 2.2 ± 0.8 μV at the last visit, and the mean N₉₅ amplitude of PERG was 3.4 ± 1.05 μV at 1-month, 3.3 ± 0.9 μV at 3-month, and 3.2 ± 0.9 μV at the last visit, and the mean P₅₀ and N₉₅ amplitudes were significantly higher when compared with baseline values (for each, P < .001). Mild anterior chamber inflammation in four eyes was controlled with topical corticosteroids. Eyes with diabetic macular edema treated with intravitreal bevacizumab showed improvement in visual acuity that was accompanied by improvement in PERG amplitudes. Further randomized trials are needed to investigate the role of PERG measurements in the evaluation of the efficacy of intravitreal bevacizumab injection.     

Short-term efficacy of intravitreal bevacizumab for the treatment of macular edema due to diabetic retinopathy and retinal vein occlusion

Purpose: To evaluate the short-term efficacy of intravitreal bevacizumab injection for the management of macular edema due to diabetic retinopathy and retinal vein occlusion. Methods: Patients with macular edema due to diabetic retinopathy, and retinal vein occlusion were treated with intravitreal bevacizumab and evaluated retrospectively. Standardized ophthalmic evaluation, ETDRS visual acuity measurement, and central macular thickness were performed at baseline and 1 month intervals after injection. Results: There were 23 eyes of 21 patients with macular edema due to diabetic retinopathy (14 eyes of 12 patients), and retinal vein occlusion (9 eyes of 9 patients). The mean baseline logMAR visual acuity and central macular thickness were 0.82 ± 0.27 and 604.71 ± 123.62 μm, respectively, in patients with diabetic retinopathy. There was no statistically significant difference between the mean logMAR visual acuity (P = 0.22) and central retinal thickness (P = 0.16) measurements at baseline and 3 months follow-up. The mean baseline logMAR visual acuity and central macular thickness were 0.94 ± 0.48 and 557 ± 113.9 μm, respectively, in patients with retinal vein occlusion. There was a statistically significant difference between the mean logMAR visual acuity and central retinal thickness measurements at baseline and 3 months follow-up (P < 0.01). Almost all of the eyes (88.8%) regained normal foveal configuration. Conclusions: Although our follow-up period was short and the number of patients were limited to provide specific treatment recommendations, intravitreal bevacizumab seems to be more effective for macular edema due to retinal vein occlusion than diabetic macular edema. The favorable short-term results suggest further study is needed.     

Intravitreal bevacizumab (Avastin) for retinal angiomatous proliferation

OBJECTIVE: To evaluate the short-term visual acuity and anatomic responses after intravitreal bevacizumab (Avastin, Genentech) treatment in patients with retinal angiomatous proliferation (RAP). METHODS: The authors conducted a retrospective review of consecutive patients with newly diagnosed or recurrent RAP treated with intravitreal bevacizumab (1.25 mg) during a 3-month period. Complete ocular examination was performed at baseline and follow-up visits. Interval data were analyzed statistically at 1 and 3 months follow-up. RESULTS: Twenty-three eyes of 23 patients underwent intravitreal bevacizumab treatment. The mean age of patients was 81.1 years, median baseline visual acuity of treated eyes was 20/80 (range 20/25-20/800), and mean baseline central macular thickness was 335 mum (optical coherence tomography was available for 22 eyes). Nine eyes had retinal pigment epithelial detachments (PEDs) at baseline. At 1-month follow-up, the median acuity improved to 20/60 (range 20/30-20/400) (P < 0.001), mean central macular thickness decreased to 202 microm (P < 0.001), and PED was present in only 2 eyes (P = 0.016). Seven of 23 eyes at 1 month (30.4%) had improved visual acuity, defined as halving of the visual angle, and no eyes had worse acuity, defined as doubling of the visual angle. Of the 17 eyes available for 3-month follow-up, 5 eyes (29.4%) had better visual acuity, 1 eye (5.9%) had worse acuity, and the remaining 11 (64.7%) had the same acuity. The median visual acuity at month 3 was 20/60 (range 20/25-20/400). There were no thromboembolic phenomena, endophthalmitis cases, retinal detachments, or any other adverse events. CONCLUSION: Treatment of RAP with intravitreal bevacizumab during this retrospective review resulted in a significant decrease in macular thickness and improvement or stabilization of visual acuity. Further long-term investigation is warranted given the promising short-term results.     

Intravitreal bevacizumab for refractory choroidal neovascularization (CNV) secondary to uveitis

Purpose  To assess the short-term efficacy and safety of intravitreal bevacizumab injections (IVB) for refractory choroidal neovascularization (CNV) secondary to uveitis. Methods  Ten patients affected by choroidal neovascularization secondary to uveitis unresponsive to immunosuppression associated or not with photodynamic therapy (PDT) were consecutively included. All patients underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), fluorescein (FA) and indocyanine green angiographies (ICG), optical coherence tomography (OCT) at baseline, and after IVB injection (1.25 mg/0.05 ml). Results  CNV was subfoveal in eight cases and juxtafoveal in two cases. Mean follow-up was 7.5 months. After treatment, the logMAR BCVA improved from 0.62 ± 0.4 (Snellen equivalent of 20/55) to 0.45 ± 0.35 (Snellen equivalent of 20/40) at 1 month (p = 0.01), then remained stable during the follow-up. Mean central macular thickness (CMT) was reduced from 326 ± 95 μm before treatment to 267 ± 28 μm (p = 0.03) at last visit. Mean number of IVB was 2.5. Leakage from inflammatory CNV was stopped in three eyes and decreased in seven eyes. No systemic or ocular adverse events were recorded. Conclusions  Intravitreal bevacizumab improves BCVA and reduces central macular thickness in eyes with inflammatory CNV refractory to immunosuppression associated or not with PDT. Further study is necessary to assess the efficacy and safety in the long term. None of the authors has any financial interest in this study. The authors have full control of all primary data and agree to allow Graefe’s Archive for Clinical and Experimental Opthalmology to review the data if requested.     

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background: To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema. Design: Prospective, non‐randomized, masked, interventional case series. Participants: Twenty‐four eyes of 24 subjects with centre‐involved diabetic macular oedema extending over two disc‐areas with predominant cystic changes on spectral domain optical coherence tomography were selected. Methods: Ten phakic and two pseudophakic, ocular hypertensive eyes received intravitreal dexamethasone and bevacizumab as against 12 pseudophakic, normotensive eyes that received intravitreal triamcinolone acetonide. Main Outcome Measures: Change in central macular volume on spectral domain optical coherence tomography and best‐corrected visual acuity were measured at 6‐week follow‐up. Results: Baseline data were matched in both groups. Post‐injection central macular volume (7.46 ± 0.73 mm³) was significantly lower (P < 0.001) in the intravitreal triamcinolone acetonide group when compared with its pre‐injection central macular volume (9.11 ± 1.0 mm³) or when compared with the post‐injection central macular volume (P = 0.02) of the intravitreal dexamethasone and bevacizumab group (8.42 ± 1.18 mm³). However, post‐injection best‐corrected visual acuity between the intravitreal triamcinolone acetonide (0.65 ± 0.15 logMAR) and the intravitreal dexamethasone and bevacizumab groups (0.685 ± 0.15 logMAR) was not significantly different (P = 0.06) at 6 weeks. No significant correlation was noted between change in central macular volume and change in best‐corrected visual acuity (r = 0.35, P = 0.07) from the pooled data of both the groups. A fair correlation was noted between change in central macular volume and pre‐injection central macular volume (r = 0.55, P = 0.005). Conclusions: Intravitreal triamcinolone acetonide may be more effective than intravitreal dexamethasone and bevacizumab in reducing macular volume in patients with diffuse cystoid diabetic macular oedema. A significant reduction in macular volume does not necessarily translate into a correspondingly significant improvement in best‐corrected visual acuity.     

Therapeutic effect of subconjunctival injection of bevacizumab in the treatment of corneal neovascularization

Purpose: To investigate the efficacy of subconjunctival injection of bevacizumab in the treatment of patients with corneal neovascularization. Methods: Twenty‐nine eyes of 29 patients with corneal neovascularization were treated with subconjunctival injection [1.25 mg/0.05 ml (seven eyes), 2.5 mg/0.1 ml (15 eyes) and 5.0 mg/0.2 ml (seven eyes)] of bevacizumab. Best‐corrected visual acuity, intraocular pressure and area of corneal neovascularization were measured before injection and at 1 week, 1 month and 3 months after treatment. Results: At 1 week, the mean neovascularized corneal area decreased significantly to 85.5 ± 18.0% (p = 0.01) in the eyes treated with 2.5 mg bevacizumab and to 73.1 ± 23.4% (p = 0.02) in the eyes treated with 5.0 mg bevacizumab. At 3 months, the mean neovascularized corneal area was 93.6 ± 10.6% (p = 0.10 compared to baseline; p < 0.01 compared to 1 week) in the eyes treated with 2.5 mg bevacizumab and 83.3 ± 25.8% (p = 0.03 compared to baseline; p = 0.02 compared to 1 week) in the eyes treated with 5.0 mg bevacizumab. However, there were no significant changes in the areas of the eyes injected with 1.25 mg bevacizumab. Conclusion: Subconjunctival injection of bevacizumab can partially reduce corneal neovascularization in the short term, and the efficacy of this treatment correlates with the injection dose.     

Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion: one-year results

Purpose To report on the anatomic and visual acuity response after intravitreal bevacizumab injection in patients with macular edema due to non-ischemic central retinal vein occlusion (CRVO). Methods In a retrospective study, 21 consecutive patients (21 eyes) with non-ischemic CRVO underwent, on average, 3.7 intravitreal bevacizumab injections (1.25 mg). Ophthalmic examination included best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline and follow-up visits. Fluorescein angiography was performed at baseline and at follow-up visits if needed. Primary outcomes were change of BCVA and CRT. Results The follow-up period for all of the included patients was 12 months. The mean BCVA was unchanged at the 12-month examination (baseline: 20/160; 12 months: 20/160) (P = 0.771). The mean CRT decreased from 780 μm (standard deviation [SD] ± 324 μm) at the baseline to a mean of 462 μm (SD ± 248 μm) at 12 months (P < 0.05). Conclusion Intravitreal bevacizumab resulted in a significant decrease in CRT without significant improvement of visual acuity in patients with non-ischemic CRVO after a follow-up of 12 months.     

Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy

Background  Vitreous concentration of vascular endothelial growth factor (VEGF) rises significantly during proliferative diabetic retinopathy (PDR). Bevacizumab (Avastin) is a humanized monoclonal antibody to VEGF. Intravitreal administration of bevacizumab (IVB) has recently been shown to be effective in some ocular neovascularizations, including PDR. In this study we evaluate the efficacy of IVB in eyes with active, progressive PDR. Methods  In an interventional prospective case series, eyes with active, progressive PDR underwent one to three IVB injections (1.25 mg) at intervals of either 6 or 12 weeks. Complete ophthalmic examinations and color fundus photography were performed at baseline and 1, 6, 12, and 20 weeks after the first injection. Fluorescein angiography (FA) was performed before injection and 20 weeks after. The primary outcome measures were clearing of vitreous hemorrhage (VH) and regression of active fibrovascular tissue (FVT). The secondary outcomes were any change in best-corrected visual acuity (BCVA) and any incidence of adverse events. Results  Thirty eight eyes of 38 patients with a mean age of 54.7 ± 10.1 years were included in the study. VH resolved significantly after 1 week (P = 0.014), 12 weeks (P = 0.0001), and 20 weeks (P = 0.002). The vascular component of FVT regressed, though the FVT area did not change. Mean BCVA improved significantly compared to baseline at all follow-up examinations. Two cases showing moderate fibrous proliferation developed traction retinal detachment (TRD). Conclusions  IVB has significant therapeutic effect on eyes with active, progressive PDR: the treatment causes a significant amount of VH resolution and neovessel regression. At the same time, this procedure may increase the risk of TRD in eyes with fibrous proliferation. The authors have no proprietary interest in this study. The authors have full control of all primary data, and they agree to allow Graefes Archive for Clinical and Experimental Ophthalmology to review their data upon request.     

High-dose intravenous methylprednisolone in recent traumatic optic neuropathy; a randomized double-masked placebo-controlled clinical trial

Background To compare the effect of high-dose intravenous corticosteroid therapy with placebo in the treatment of recent traumatic optic neuropathy (TON). Methods In a double-masked placebo-controlled clinical trial, 31 eyes of 31 patients were randomly assigned to two groups. Patients with history of trauma ≤7 days were included. Unconscious patients, eyes with penetrating trauma and candidates for decompression surgery were excluded. The treatment group (16 eyes) received 250 mg methylprednisolone intravenously every 6 h for 3 days, then 1 mg/kg prednisolone orally for 14 days; the placebo group (15 eyes) received 50 ml normal saline intravenously every 6 h for 3 days, then placebo for 14 days. Visual improvement was considered as a decrease of at least 0.4 logMAR in final visual acuity. Results Mean final BCVA (best corrected visual acuity) in the treatment group was 1.11± 1.14 and the placebo group was 1.78 ± 1.23. This difference was not significant (P = 0.13). Visual acuity was improved in 68.8% of the treatment group and 53.3% of the placebo group, but the difference was not statistically significant (P = 0.38). The difference between initial and final BCVA in both groups was determined to be statistically significant (P < 0.001 and 0.010 respectively). Conclusions Our study confirms earlier findings that there is no difference in visual acuity improvement between intravenous high-dose corticosteroids and placebo in treatment of recent TNO. None of the authors has a financial interest in the subject matter of the presentation.     

Changes in choriocapillaris fenestration of rat eyes after intravitreal bevacizumab injection

Background  To examine the effects of anti-VEGF antibody (bevacizumab) on the number of fenestrations in rat choriocapillaris. Methods  Twenty-four eyes from 24 male Wister rats were injected intravitreally with 0.125 mg of bevacizumab. The rats were perfusion fixated at 1, 3, 7, 14 or 28 days after injection. The surfaces of the choriocapillaris on the RPE side were observed using scanning electron microscopy. Four eyes treated with human IgG were used as controls. The area sieve plate and the number of fenestrations after the bevacizumab injection were measured and compared with controls. Results  In the controls, the sieve plate area was 80.7% of the total choriocapillaris area. The number of fenestrations was 69.2 ± 0.2 /μm² of the fenestrated area. While there were no changes in the fenestrated area for any of the time points after the bevacizumab treatment, the number of fenestrations was significantly reduced to 52.9 ± 4.4 at day 1, 55.6 ± 3.6 at day 3 and 53.6 ± 8.6 /μm² of the luminal surface at day 7 (ANOVA, p < 0.05). Conclusions  In this study, intravitreal bevacizumab injection reduced fenestration of the normal choriocapillaris. These results indicate there is a latent risk inherent with bevacizumab treatment of normal choriocapillaris. This work was presented in part at the 80th Annual Meeting of the Association for Research in Vision and Ophthalmology, 2008.     

Photodynamic therapy for choroidal neovascularization in young adult patients

We report our experience with photodynamic therapy (PDT) in the treatment of choroidal neovascularization (CNV) in young adult patients. This was a retrospective study of young adults with CNV treated with PDT. Data collected included age, diagnosis, type and size of CNV, number of treatments, visual outcome, and side effects. Ten patients (11 eyes) were included in the study (mean age 27.2 ± 13.3 years). Etiologies included multifocal choroiditis (3 eyes), idiopathic CNV (5 eyes), central serous chorioretinopathy (1 eye), and toxoplasma (2 eye). The mean number of treatments was 2 ± 0.7 and the mean follow-up time was 13.1 ± 9.5 months. Initial visual acuity (VA) ranged from 20/25 to 20/1,200 (mean logMAR 0.6 ± 0.5), and improved to 20/20 to 20/250 (mean logMAR 0.46 ± 0.4) (P = 0.51). Of the four eyes that received additional treatment with oral steroids, one of which also received intravitreal bevacizumab (Avastin) injections, all had visual acuity improvement of 2 or more lines, while only two of seven eyes that received PDT alone showed such improvement. PDT can improve visual outcome in a subgroup of young patients with subfoveal CNV especially when supplemented with oral steroid and bevacizumab injections.     

Intravitreal bevacizumab therapy for neovascular age-related macular degeneration: a pilot study

Purpose To evaluate the efficacy and safety of intravitreal bevacizumab therapy for neovascular age-related macular degeneration (ARMD). Methods Patients with diagnosis of neovascular ARMD without any other ocular pathology were injected with 2.5 mg of intravitreal bevacizumab. A complete ophthalmic examination was undertaken in all patients, including best corrected visual acuity (BCVA), slit lamp biomicroscopy and ocular fundus examination. Ophthalmic follow-up evaluations included visual acuity measurements, optical coherence tomography (OCT) imaging, and fluorescein angiography at first, second and fourth week post injection. Results 39 eyes of 39 patients were injected. The median age was 76 years-old (range 65–90), median visual acuity was 1.18 logMAR (range 0.18–3.00) and median retinal thickness was 388 microns (range 157–1237). By the fourth week of treatment, the median visual acuity was 0.88 (range 0.18–2.78) and median retinal thickness was 247 microns (range 108–1262). Statistically significant differences were found in visual acuity and retinal thickness before and after intravitreal injection (p=0.002, p<0.001, Wilcoxon rank test). Conclusions Our results suggest that intravitreal bevacizumab is well tolerated and is associated with improvement in BCVA and decreased mean retinal thickness by OCT. Further controlled and long term evaluation of intravitreal bevacizumab for the treatment of neovascular ARMD is warranted.     

Intravitreal bevacizumab (Avastin) in combination with verteporfin photodynamic therapy for choroidal neovascularization associated with age-related macular degeneration (IBeVe Study)

Background A novel alternative for combined treatment using verteporfin photodynamic therapy (PDT) has emerged as preliminary safety and efficacy data of the intravitreal use of the anti-angiogenic bevacizumab became available. In the current study we investigate the feasibility of intravitreal bevacizumab combined with verteporfin PDT for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods A single-centre, prospective, open-label study of 11 patients with documented CNV progression after PDT treatment who underwent combined PDT and intravitreal injection of 1.5 mg of bevacizumab was undertaken. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 2, 12 and 24. Clinical evidence of complications and changes in logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and in fluorescein leakage from CNV were evaluated. Results The mean (±SD) age of the 11 patients was 74 (±5) years. Seven eyes had been treated with one previous PDT session and four eyes had two previous PDT sessions. The mean baseline logMAR ETDRS BCVA was 1.031 (Snellen equivalent, 20/200⁻²). At follow-up weeks 1, 2, 12 and 24, the mean logMAR ETDRS BCVA (Snellen equivalent) was 0.944 (20/160⁻²), 0.924 (20/160⁻¹), 0.882 (20/160⁺¹), and 0.933 (20/160⁻²), respectively. The change in BCVA from baseline was significant at each study follow-up interval (P ≤ 0.001); at 12 and 24 weeks, the mean change in BCVA from baseline was an improvement of 1.49 and of 0.98 ETDRS line, respectively. Fluorescein leakage from CNV was absent in all eyes at week 12. One additional treatment session was required in seven (63.6%) eyes at week 24 due to recurrent fluorescein leakage from CNV (“minimum” [<50% of the leaking area noted at baseline], n = 4; and “moderate” [>50% of the leaking area noted at baseline], n = 3). No progression of the neovascular lesion was observed at week 24. No safety issues were identified throughout the period of the study. Conclusions The overall changes in vision and fluorescein leakage from CNV throughout the study suggest that a possible synergistic effect may arise from the combination of intravitreal bevacizumab with verteporfin PDT for the treatment of neovascular AMD. In terms of funding, this was an investigator’s driven study.     

Intravitreal bevacizumab injection for recurrent vitreous haemorrhage after diabetic vitrectomy

Purpose: To evaluate the efficacy of intravitreal bevacizumab in treating recurrent vitreous haemorrhage (VH) after diabetic vitrectomy. Methods: Consecutive patients with postoperative recurrent VH ≥ 2 weeks after primary diabetic vitrectomy were treated with intravitreal bevacizumab. Repeated injection was given after 2–3 weeks in case of no obvious blood reabsorption (study group). Consecutive patients with the same complication but without bevacizumab injection served as the control group. Vitreous surgeries in both groups were indicated if no clinical improvement was noted 10–12 weeks after the initial bleeding. Vitreous clear‐up time (VCT), vitreous surgeries and rebleeding rates, and visual acuity changes were compared between both groups. Results: The study group had 20 eyes (20 patients) and the control group had 18 eyes (18 patients). Postoperative VH occurred between 1 and 25 months and between 1 and 18 months, respectively. In the study group, VCT after the first recurrent VH was 6.5 ± 1.5 weeks with 2.2 ± 0.8 injections. Nine cases had ≥ one episode of VH, but no surgery was needed. In the control group, 13 eyes had spontaneous re‐absorption (in 6.4 ± 1.3 weeks); five eyes underwent surgeries; three of the 13 eyes eventually had surgeries after further recurrent VH. The rate of vitreous surgery in the two groups was 0/20 and 8/18 (p = 0.01). The total number of rebleeding was 30 in the study group and 27 in the control group (p = 0.69). Conclusion: Intravitreal bevacizumab treatment may reduce the need of revitrectomy for recurrent vitreous haemorrhage after diabetic vitrectomy.     

Comparison of contrast sensitivity,depth of field and ocular wavefront aberrations in eyes with an IOL with zero versus positive spherical aberration

Purpose  To compare the clinical performance of the zero spherical aberration (SA) SofPort LI61AO (AO, Bausch & Lomb) intraocular lens (IOL) to the AcrySof SA60AT (AT, Alcon), which has positive spherical aberration. Methods  Patients underwent uneventful phacoemulsification with implantation of either an aspheric (AO, n = 19) or spherical (AT, n = 20) IOL. Postoperatively, a 5 mm artificial pupil was positioned in trial frames with the cycloplegic refraction during monocular, mesopic contrast sensitivity (CSF) and low-contrast visual acuity (LCVA) testing with glare. Ocular and corneal wavefront error was determined at 5 mm diameters. Results  Mean CSF scores were better at all frequencies tested for the AO than for the AT group, and achieved statistical significance at 1.5 cpd (p = 0.038) and 6 cpd (p = 0.017). With glare, AO eyes read 30.9 ± 5.0 low-contrast letters versus 25.2 ± 6.8 for AT eyes (p = 0.005) (mean ΔLogMAR  =  −0.10), while high-contrast acuity and refraction were similar. Eyes implanted with the SA60AT had 43% greater positive spherical aberration at a 5 mm wavefront diameter, with no significant difference in corneal SA between groups. A through-focus analysis demonstrated a similar depth of field, yet a comparatively higher visual Strehl ratio for the aspheric IOL at emmetropia (p = 0.038). Conclusion  Eyes with the SofPort Advance Optics neutral aberration IOL demonstrated less spherical aberration and better low-contrast acuity compared to eyes with a spherical IOL, without sacrificing tolerance to defocus. The aspheric IOL showed superior optical and clinical performance, which is most likely due to its surface design. Supported in part by research grants from the Midwest Cornea Foundation, St. Louis, MO, USA and Bausch & Lomb, Rochester, NY, USA. Drs. Pepose, Qazi and Sanderson have no financial interest in the products described. Dr. Pepose has received research and travel support from Bausch & Lomb. Dr. Sarver has a financial interest in the VOL-CT Software used in this study. Mr. Edwards is an employee of Bausch & Lomb. Dr. Pepose is a paid consultant for Bausch & Lomb, Rochester, NY, USA     

Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab

The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on visual outcome in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Retrospective chart review of patients who underwent PPV for PDR and followed for at least 6 months after surgery. Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to group A. Those who did not receive IVB were assigned to group B. The primary outcome measure was visual outcome at 6-month follow-up. The secondary outcomes were postoperative complications. At 6 months, visual acuity improved by at least 0.3 logMAR units in 70 (74.5 %) of the 94 eyes in group A versus 46 (52.9 %) of the 87 eyes in group B (p = 0.002). Postoperative vitreous hemorrhage occurred significantly less frequently in group A (6 eyes, 6.4 %) than in group B (14 eyes, 16.1 %; p = 0.037). The incidence of other postoperative complications did not differ significantly between the two groups. Preoperative use of bevacizumab improved the 6-month visual outcome in patients undergoing PPV for PDR and significantly reduced the occurrence of postoperative vitreous hemorrhage.