Abstract :
Introduction: Elevated levels of VEGF is implicated in the pathogenesis of ocular neovascular diseases such as exudative age-related macular degeneration, proliferative diabetic retinopathy, diabetic macular edema, central and branch retinal vein occlusion, neovascular glaucoma, and retinopathy of prematurity. Bevacizumab a full- length humanized murine monoclonal antibody is being used as an off-label drug in the treatment of above disorders. When administered intravitreally, bevacizumab may have a therapeutic effect in the uninjected fellow eye. The objective of the present study is to determine the effects in the untreated fellow eye of intravitreal bevacizumab after a single dose in the contralateral affected eye in patients with similar retinal pathology.
Materials and Methods: The study was a non-randomized, interventional prospective study. Thirty consecutive patients with similar retinal pathologies in both the eyes were enrolled. All patients in the study underwent a detailed ophthalmic examination including a dilated fundus examination. All patients underwent fundus fluorescein angiography and optical coherence tomography of macula. All suitable patients identified were given intravitreal injections of 1.25 mg bevacizumab. The eye to be injected was selected based on the severity of pathology, affecting the macular status, as depicted by the clinical picture, visual acuity, OCT and FFA. The injections were given under topical anaesthesia. Patients were subsequently followed up on day 2, day 7 and day 21. After 4 weeks FFA and OCT were repeated. The results were tabulated and statistical analysis was done.
Results: The study included 30 eyes of 30 patients with similar retinal pathology in both the eyes the mean age of patients was 64 yrs. 10 eyes had AMD, 9 eyes had PDR, 5 eyes had CNVM, 3 eyes had CME, 2 eyes had myopic CNVM, 1 eye had CRVO. The mean visual acuity at presentation in the uninjected fellow eye was 0.69 ± 0.41 log MAR units. All patients received atleast one intravitreal injection of bevacizumab 1.25mg in one of the affected eyes and the response was observed in the fellow eye. Among the 30 patients who received injection, 29(72.5%) patients showed some improvement in visual acuity chart after the first injection in the fellow eye and in 11(27.5%) patients vision remained same. The initial improvement was seen within one week in most patients. The mean central macular thickness in the fellow eye on OCT at baseline 515.64 1.
Keyword :
Bevacizumab, CRVO, PDR.