Primary Intravitreal Bevacizumab (Avastin) for Diabetic Macular Edema: Results from the Pan-American Collaborative Retina Study Group at 6-Month Follow-up
Presented in part at: American Academy of Ophthalmology joint meeting with the Asia Pacific Academy of Ophthalmology, November 2006, Las Vegas, Nevada.
Received 10 October 2006; accepted 21 December 2006.
Purpose
To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME).
Design
Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME.
Participants
We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventy-eight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7±9.3 years were included in this analysis.
Intervention
Patients were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab and underwent Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Repeated-measures analysis of variance was used to compare mean values.
Main Outcome Measures
Changes in BCVA, OCT, and FA.
Results
Mean follow-up was 6.31±0.81 months (range, 6–9). Sixteen (20.5%) eyes needed a second injection at a mean of 13.8 weeks (range, 4–28), and 6 eyes needed a third injection (7.7%) at a mean of 11.5 weeks (range, 5–20). The mean baseline BCVA was 0.87 (logarithm of the minimum angle of resolution), and the final mean BCVA was 0.6, a difference that was statistically significant (P<0.0001). Final BCVA analysis by subgroups demonstrated that 32 (41.1%) eyes remained stable, 43 (55.1%) improved ≥2 ETDRS lines of BCVA, and 3 (3.8%) decreased ≥2 ETDRS lines of BCVA. Mean central macular thickness at baseline by OCT was 387.0±182.8 μm and decreased to a mean of 275.7±108.3 at end of follow-up (P<0.0001). No ocular or systemic adverse events were observed.
Conclusions
Primary intravitreal bevacizumab at doses of 1.25 to 2.5 mg seem to provide stability or improvement in VA, OCT, and FA in DME at 6 months. Follow-up is still short to make any specific treatment recommendations; however, the results appear promising. Evaluation in a multicenter randomized controlled clinical trial with longer follow-up is needed.
1Retina and Vitreous Service, Clinica Oftalmológica Centro Caracas, Caracas, Venezuela.
2Asociacion para Evitar la Ceguera en Mexico, Hospital Dr Luis Sanchez Bulnes, Mexico City, Mexico.
3Instituto de Cirugia Ocular, San Jose, Costa Rica.
4Departamento de Oftalmologia, Instituto da Visão, Universidade Federal de São Paulo, São Paulo, Brazil.
5University of Puerto Rico, San Juan, Puerto Rico.
Correspondence to J. Fernando Arevalo, MD, FACS, Clinica Oftalmologica Centro Caracas, Edif. Centro Caracas PH-1, Av. Panteon, San Bernardino, Caracas 1010, Venezuela.
Manuscript no. 2006-1152.
Supported in part by the Arevalo–Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela.
The authors have no financial or proprietary interest in any of the products or techniques mentioned in the article.
⁎ For a complete listing of participating members, see “Appendix.”
ABSTRACT