Intravitreal Bevacizumab for Diabetic Macular Edema Associated With Severe Capillary Loss: One-Year Results of a Pilot Study

• Published in: American journal of ophthalmology 2009-06, Vol.147 (6), p.1022-1030.e5
• Main Authors: Bonini-Filho, Marco, Costa, Rogério A, Calucci, Daniela, Jorge, Rodrigo, Melo, Luiz A.S, Scott, Ingrid U
• Format: Article
• Language: English
• Subjects: Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Bevacizumab; Biological and medical sciences; Blood pressure; Capillaries - pathology; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - drug therapy; Diabetic Retinopathy - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fluorescein Angiography; Follow-Up Studies; Heart attacks; Hemophilia; Humans; Hypertension; Injections; Ischemia; Lasers; Macular degeneration; Macular Edema - diagnosis; Macular Edema - drug therapy; Macular Edema - physiopathology; Male; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Pilot Projects; Prospective Studies; Retinal Vessels - pathology; Retinopathies; Tomography, Optical Coherence; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Vitreous Body
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2009.01.009

Purpose To evaluate the effects of intravitreal bevacizumab in patients with diabetic macular edema (DME) associated with severe capillary loss. Design Multicenter, open-label, nonrandomized study. Methods setting: Two tertiary ophthalmic referral centers in Brazil. study population: Ten consecutive patients with DME and “severe” capillary loss. observation procedures: Intravitreal injection(s) of bevacizumab (1.5 mg). Standardized ophthalmic evaluation was performed at baseline and at weeks 8, 16, 24, and 54. main outcome measures: Changes in best-corrected visual acuity (BCVA) and in optical coherence tomography variables (central macular thickness [CMT] and total macular volume [TMV]). Results Significant changes in BCVA and in CMT/TMV were noted throughout the study ( P < .001, P = .009, and P < .001, respectively). The mean logarithm of the minimal angle of resolution Early Treatment Diabetic Retinopathy Study BCVA was 0.786 (∼20/125+1 ) at baseline, 0.646 (∼20/80−2 ) at week 8, 0.580 (20/80+1 ) at week 16, 0.574 (∼20/80+1 ) at week 24, and 0.558 (∼20/80+2 ) at week 54. Compared with baseline, a significant change in BCVA was noted at all follow-up visits ( P ≤ .008). The mean CMT/TMV values were, respectively, 472.6/10.9 at baseline, 371.4/9.9 at week 8, 359.5/9.8 at week 16, 323.9/9.4 at week 24, and 274.6/8.7 at week 54. Compared with baseline, a significant change in both CMT and TMV was noted only at 24 and 54 weeks ( P ≤ .007). At 54 weeks, fluorescein angiography demonstrated no change in the extent of macular capillary loss and reduced dye leakage as compared with baseline in all patients. Conclusions Favorable changes in BCVA and in CMT/TMV observed throughout 1 year suggest that intravitreal bevacizumab may be a viable alternative treatment for the management of patients with DME and severe capillary loss.