DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20194976

Fundus fluorescein angiographic assessment of patients with proliferative diabetic retinopathy and macular edema before and after intravitreal injection of Bevacizumab

Ankur ., Yogesh Kumar, Deepesh Arora, Rupali Tyagi, Sanjeev Kumar Mittal

Abstract


Background: To assess the role of intravitreal bevacizumab (1.25 mg) in patients with proliferative diabetic retinopathy with macular edema in terms of change in leakage area and best-corrected visual acuity.

Methods: This prospective randomized interventional study was conducted in the Department of Ophthalmology from September 2013 to August 2015 and included thirty eyes of twenty patients.

After a detailed history and ocular examination, diagnosed cases of proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) underwent sequential fundus fluorescein angiography. Bevacizumab was administered intravitreally. Patients were assessed two hours after injection for anterior chamber reaction and intraocular pressure and were advised follow-ups at 24 hours and then at 1, 4, 8 and 12 weeks. For the outcome, the change of retinal new vessels by assessment of leakage area using Quantitative Planimetric Analysis (QPA) of photographs as well as the change in best-corrected visual acuity (BCVA) from baseline to the 12 weeks follow-up, were done. Results were analyzed statistically by applying t-test.

Results: Intravitreal bevacizumab injection lead to a significant decrease in leakage in DME and PDR, and improvement in mean BCVA. The effect was maximum at 4 weeks which weaned off as the study progressed through it remains statistically significant at the end of 12 weeks.

Conclusions: Intravitreal bevacizumab plays a major role in treating and reducing visual deterioration in patients with proliferative diabetic retinopathy and diabetic macular edema.


Keywords


Diabetic retinopatthy, Fluoroscien angiography neovasculariztion, Intravitreal bevacizumab, Macular edema

Full Text:

PDF

References


Powers AC. Diabetes Mellitus. In: Kasper DL, Fauci AS, Longo DL, Hauser SL, Jameson JL, Loscalzo J, Editors. vol.2. Harrison's principles of internal medicine, 19th ed. New York: McGraw-Hill;2015:2399.

Retinal Vascular Disease: Diabetic Retinopathy. Retina and Vitreous (sec. 12). In: American Academy of Ophthalmology: Basic and Clinical Science Course, 2012-2013 Ed. San Francisco: Life Long Education for the Ophthalmologist; 2012:89.

Park K. Epidemiology of Non-Communicable Diseases. In: Park K, editor. Textbook of Preventive and Social Medicine, 23rd Ed. Jabalpur: Banarsidas Bhanot; 2015:393.

Powers AC. Complications of Diabetes Mellitus. In: Kasper DL, Fauci AS, Longo DL, Hauser SL, Jameson JL, Loscalzo J, Editors: vol.2 Harrison's principles of internal medicine, 19th Ed. New York: McGraw-Hill; 2015:2422-2424.

Limb LL, Rosenblatt BJ, Benson WE. Diabetic Retinopathy. In: Yanoff M, Duker J, Augsburger J, editors. Ophthalmology, 4th Ed. Edinburgh: Elsevier Sunders; 2014:541.

Wiley HE, Ferris III FL. Nonproliferative Diabetic Retinopathy and Diabetic Macular Edema. In: Schachat AP, Sadda SR, editors. Medical Retina (vol.2.). In: Ryan SJ, Editor. Retina, 5th Ed. London: Elsevier saunders; 2013:940-964.

Silva PAS, Cavallerano JD, Sun JK, Blodi BA, Davis MD, Aiello LM et al. Proliferative Diabetic Retinopathy. In: Schachat AP, Sadda SR, editors. Medical Retina (vol.2). In: Ryan SJ, editor. Retina, 5th Ed. London: Elsevier saunders; 2013:969-997.

Adamis AP, Miller JW, Bernal MT, D'Amico DJ, Folkman J, Yeo TK, et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am J Ophthalmol. 1994;118(4):445-50.

Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994; 331: 1480-87.

Pe’er J, Shweiki D, Itin A, Hemo I, Gnessin H, Keshet E. Hypoxia-induced expression of vascular endothelial growth factor by retinal cells is a common factor in neovascularizing ocular diseases. Lab Invest. 1995;72:638-45.

Watanabe D, Suzuma K, Suzuma I, Ohashi H, Ojima T, Kurimoto M et al. Vitreous levels of angiopoietin 2 and vascular endothelial growth factor in patients with proliferative diabetic retinopathy. Am J Ophthalmol. 2005;139:476-81.

Tolentino MJ, McLeod DS, Taomoto M, Otsuji T, Adamis AP, Lutty GA. Pathologic features of vascular endothelial growth factor-induced retinopathy in the nonhuman primate. Am J Ophthalmol. 2002;133:373-85.

Adamis AP, Altaweel M, Bressler NM, Cunningham Jr ET, Davis MD, Goldbaum M et al. Changes in retinal neovascularization after pegaptanib (Macugen) therapy in diabetic individuals. Ophthalmology. 2006;113:23-8.

Spaide RF, Fisher YL. Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina. 2006;26:275-8.

Ferrara N, Hillan KJ, Gerber HP, Novotny W. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004;3:391-400.

Filho J, Messias A, Almeida F, Ribeiro J, Costa R, Scott I et al. Panretinal photocoagulation (PRP) versus PRP plus intravitreal ranibizumab for high-risk proliferative diabetic retinopathy. Acta Ophthalmologica. 2011;89:567-72.

Seo J, Park I. Intravitreal Bevacizumab for Treatment of Diabetic Macular Edema. Korean J Ophthalmol. 2009;23:17.

Özkiriş A. Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular oedema. Eye 2008;23:616-20.

Haritoglou C, Kook D, Neubauer A, Wolf A, Priglinger S, Strauss R, et al. Intravitreal Bevacizumab (avastin) therapy for persistent Diffuse Diabetic Macular Edema. Retina. 2006;26:999-1005.

Arevalo J, Sanchez J, Fromow-Guerra J, Wu L, Berrocal M, Farah M et al. Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up. Graefes Arch Clin Exp Ophthalmol. 2009;247:735-43.

Soheilian M, Ramezani A, Bijanzadeh B, Yaseri M, Ahmadieh H, Dehghan M et al. Intravitreal Bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of Diabetic Macular Edema. Retina. 2007;27:1187-95.

Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina 2006; 26:1006-13.

Arevalo J, Wu L, Sanchez J, Maia M, Saravia M, Fernandez C et al. Intravitreal bevacizumab (avastin) for proliferative diabetic retinopathy: 6-months follow-up. Eye. 2007;23(1):117-23.

Minnella A, Savastano C, Ziccardi L, Scupola A, Sasso P, Falsini B et al. Intravitreal bevacizumab (Avastin®) in proliferative diabetic retinopathy. Acta Ophthalmologica 2008;86:683-7.

S Pillai G, Khake A, Pehere N, Nambyar R, Bhat L, Rao A et al. Intravitreal Bevacizumab in Diabetic Retinopathy. Kerala J Ophthalmol. 2015;11:266-9.

Baig MS, Rehman A, Burney JA. Intravitreal bevacizumab (Avastin) for proliferative diabetic retinopathy. Pakistan J Sur. 2009;25(2):110-4.

Jahangir T, Jahangir S, Tayyab H, Hamza U. To determine the effect of intravitreal bevacizumab (Avastin) on visual acuity in patients with persistent diabetic macular edema. Pak J Ophthalmol. 2011;27(4):187-90.

Kumar A, Sinha S. Intravitreal bevacizumab (Avastin) treatment of diffuse diabetic macular edema in an Indian population. Indian J Ophthalmol. 2007;55:451.

Ahmadieh H, Ramezani A, Shoeibi N, Bijanzadeh B, Tabatabaei A, Azarmina M et al. Intravitreal bevacizumab with or without triamcinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial. Graefes Arch Clin Exp Ophthalmol. 2007;246:483-89.

Lam D, Lai T, Lee V, Chan C, Liu D, Mohamed S et al. Efficacy of 1.25 mg versus 2.5 mg intravitreal bevacizumab for diabetic macular edema. Retina. 2009;29:292-9.