Intravitreal bevacizumab for myopic choroidal neovascularization.

BACKGROUND AND OBJECTIVE: To evaluate the effect of intravitreal bevacizumab on visual acuity in patients with myopic choroidal neovascularization. PATIENTS AND METHODS: The retrospective case series study included 13 patients with myopic choroidal neovascularization who received three intravitreal injections of 1.5 mg of bevacizumab. RESULTS: At 1, 3, and 6 months after the first injection, mean visual acuity improved significantly from 0.63 +/- 0.41 logarithm of the minimum angle of resolution units (LogMAR) to 0.39 +/- 0.22 (P< .001), 0.47 +/- 0.49 (P= .002), and 0.52 +/- 0.49 LogMAR (P = 0.009), respectively. The increase in visual acuity was correlated with a significant decrease in central retinal thickness (P = .003) as measured by optical coherence tomography. Mean intraocular pressure did not change significantly (P> .05) during follow-up. CONCLUSION: Intravitreal injections of bevacizumab may be a therapeutic option for exudative myopic macular degeneration.

Infectious and noninfectious endophthalmitis after intravitreal bevacizumab.

AIMS: The aim of this study was to evaluate the rate of infectious and noninfectious endophthalmitis after an intravitreal injection of bevacizumab. METHODS: This clinical interventional case-series study included 1218 intravitreal injections of 1.5 mg of bevacizumab consecutively performed for 684 eyes with exudative age-related macular degeneration. Among the injections were 534 reinjections. Follow-up after each injection was at least 4 weeks. RESULTS: One (1) eye developed an infectious endophthalmitis 3 days after a second injection. In none of the other eyes, were signs of an infectious or noninfectious endophthalmitis observed with the cellular infiltration or amorphous opacification of the vitreous as marked by the Tyndall phenomenon in the anterior chamber, retinal infiltration, or pain. CONCLUSIONS: The rate of infectious endophthalmitis after an intravitreal injection of 1.5 mg bevacizumab may be approximately 1:1000, similar to injections of other drugs available thus far.

Intravitreal bevacizumab combined with cataract surgery for treatment of exudative macular degeneration.

PURPOSE: The aim of this study was to report on the combination of an intravitreal injection of bevacizumab and cataract surgery in patients with exudative age-related macular degeneration (AMD). METHODS: The interventional case series study included 11 patients (11 eyes) who received an intravitreal injection of 1.5 mg bevacizumab as treatment of exudative AMD (n = 10) or exudative myopic macular degeneration (n = 1), combined with a routine phacoemulsification and posterior chamber lens implantation for treatment of cataract. RESULTS: Intraoperatively and during the follow-up of 150 +/- 77.5 days, there were no complications related to the intravitreal application of bevacizumab combined with cataract surgery, such as wound dehiscence and leakage, delayed wound healing, corneal edema, dislocation of the pseudophakos, rupture of the posterior lens capsule, or rhegmatogenous retinal detachment. CONCLUSIONS: The results of this pilot study suggest that from a safety point of view, intravitreal injections of bevacizumab may be combined with routine cataract surgery.

Intravitreal low-dosage bevacizumab for retinopathy of prematurity.

PURPOSE: To report on the therapeutic effect of intravitreal low-dose bevacizumab for treatment for retinopathy of prematurity (ROP). METHODS: The single-centre retrospective, non-comparative case series study included all infants who consecutively underwent intravitreal injection of 0.375 mg bevacizumab (0.03 ml) under light sedation in topical anaesthesia as therapy of ROP in zone I or zone II. RESULTS: The clinical charts of 29 patients (57 eyes) with a median birth weight of 630 g (range: 290-1390 g) and median gestational age of 25 + 1 weeks (range: 23 + 1-30 weeks) were reviewed. Six children (12 eyes) were graded as ROP with zone I retinopathy and plus disease. The 23 remaining infants had extraretinal neovascularizations in zone II or partly zone I. The intravitreal bevacizumab injection was injected at a median age of 12 + 1 weeks (range: 7 + 4-21 + 4), the median follow-up was 4.2 months (range: from 3 days to 45.1 months). In all eyes treated, a regression of plus disease occurred within two to six days, retinal neovascularizations regressed within 2-3 weeks and pupillary rigidity improved. None except one child in exceptionally bad general health conditions needed a second intravitreal bevacizumab injection. In none of the infants, any ophthalmologic side-effects of the bevacizumab application were detected during the follow-up period. CONCLUSIONS: The intravitreal injection of a low dose of 0.375 mg bevacizumab showed a high efficacy as treatment for ROP. The question arises whether the low dosage of bevacizumab as compared to the dosage of 0.625 mg bevacizumab may be preferred.

Intravitreal bevacizumab for retinopathy of prematurity: refractive error results.

PURPOSE: To evaluate refractive error in infants who underwent intravitreal bevacizumab injection for treatment of threshold retinopathy of prematurity (ROP). DESIGN: Retrospective nonrandomized interventional comparative study. METHODS: The study group included all infants who consecutively received a single intravitreal bevacizumab (0.375 mg or 0.625 mg) injection for therapy of threshold ROP in fundus zone I or zone II. The control group included infants who had previously undergone retinal argon laser therapy of ROP. The follow-up examination included refractometry under cycloplegic conditions. RESULTS: The study group included 12 children (23 eyes; mean birth weight: 622 ± 153 g; gestational age: 25.2 ± 1.6 weeks) and the control group included 13 children (26 eyes; birth weight: 717 ± 197 g; gestational age: 25.3 ± 1.8 weeks). Both groups did not differ significantly in birth age and weight and follow-up. At the end of follow-up at 11.4 ± 2.3 months after birth, refractive error was less myopic in the study group than in the control group (-1.04 ± 4.24 diopters [median: 0 diopters] vs -4.41 ± 5.50 diopters [median: -5.50 diopters]; P = .02). Prevalence of moderate myopia (17% ± 8% vs 54% ± 10%; P = .02; OR: 0.18 [95% CI: 0.05, 0.68]) and high myopia (9% ± 6% vs 42% ± 10%; P = .01; OR: 0.13 [95% CI: 0.03, 0.67]) was significantly lower in the bevacizumab group. Refractive astigmatism was significantly lower in the study group (-1.0 ± 1.04 diopters vs 1.82 ± 1.41 diopters; P = .03). In multivariate analysis, myopic refractive error and astigmatism were significantly associated with laser therapy vs bevacizumab therapy (P = .04 and P = .02, respectively). CONCLUSIONS: In a 1-year follow-up, a single intravitreal bevacizumab injection as compared to conventional retinal laser coagulation was helpful for therapy of ROP and led to less myopization and less astigmatism.

Intravitreal bevacizumab for retinopathy of prematurity.

BACKGROUND: To evaluate the therapeutic effect of a single intravitreal injection of bevacizumab for treatment of threshold retinopathy in retinopathy of prematurity (ROP). METHODS: The retrospective study consisted of all infants who developed threshold ROP in fundus zone I or zone II and who consecutively received an intravitreal injection of bevacizumab (0.375 mg, 0.03 mL) in local anesthesia. RESULTS: Twelve infants (23 eyes) were included into the study. The mean birth weight was 625±187 g (mean±standard deviation; range: 450-810 g), mean gestational age was 25.1±1.4 weeks (range: 24.0-28.7 weeks), mean age at the time of intervention was 38.1±3.7 gestational weeks (range: 32.1-45.6 weeks), and mean follow-up was 30.4±25.9 weeks. Three children (6 eyes) showed aggressive posterior ROP. After the injection, all eyes showed a regression of plus disease within 2-6 days, a decrease in pupillary rigidity, a resolution of any tunica vasculosa lentis, and a complete regression of the retinal neovascularization within 2-3 weeks. In none of the children a second intravitreal injection of bevacizumab was performed. CONCLUSIONS: A single intravitreal bevacizumab injection of 0.375 mg in 0.03 mL appears to be potentially helpful for the therapy of threshold ROP avoiding side effects of conventional retinal laser coagulation such as irreversible retinal scarring. Long-term effects and side effects may be assessed in future prospective randomized trials.