THE USE OF AVASTIN (BECACIZUMAB) FOR THE TREATMENT OF DIABETIC MACULAR EDEMA IN IRAQI PATIENTS

Authors

  • Salah Zuhair Al-Asadi Lecturer - Medicine College, Basra University, Practicing Ophthalmologist in Basra General Hospital

Abstract

Purpose: To evaluate the effect of intravitreal bevacizumab on visual  acuity in patients with diabetic maculopathy, clinically significant macular edema (CSME). Methods: Thirty eyes of twenty-eight patients (mean age, 57.9±13.8 years) with CSME were included in this study. Complete ophthalmic examination, including determination of best corrected visual acuity (BCVA), stereoscopic biomicroscopy with +90D lens was done at baseline and at each follow-up visit. All patients were treated with a 0.1 mL intravitreal injection containing 2.5 mg of bevacizumab (Avastin). Results: All patients completed 3 months of follow-up with a mean follow-up period of 5.26±2.39 months. The mean BCVA at baseline was 0.73±0.36 logMAR, which significantly improved to 0.63±0.41 (p=0.02), 0.58±0.36 (p=0.003), and 0.61±0.40 logMAR (p=0.006) at 1 week, 1month, and 3 months. Final BCVA analysis demonstrated that 15 eyes (50%) remained stable and 12 (40%) improved ≥2 lines on BCVA. No ocular toxicity or significant side effects were observed. Conclusions: Intravitreal bevacizumab injection resulted in significant improvement in BCVA  as early as 1 week after injection in patients with CSME, and this beneficial effect persisted for up to 3 months. However, the slight reduction in this improvement at 3 months suggests that repeated bevacizumab injections might be necessary. To evaluate the long-term safety and efficacy, further prospective randomized controlled clinical trials will be needed.

References

Ferris FL 3rd, Patz A. Macular edema: a complication of diabetic retinopathy. Surv Ophthalmol 1984;28:452-61.

Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 1. Early Treatment Diabetic Retinopathy Study Research Group. Arch phthalmol

;103:1796-806.

Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol 2003;121:57-61.

Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Am J Ophthalmol 2002;109:920-7.

Jonas JB, Kreissig I, Degenring RF. Intraocular pressure after intravitreal injection of triamcinolone acetonide. Br J Ophthalmol 2003;87:24-7.

Patelli F, Fasolino G, Radice P, et al. Time course of changes in retinal thickness and visual acuity after intravitreal triamcinolone acetonide for diffuse diabetic macular edema with and without previous macular laser treatment. Retina 2005;26:840-5.

Qaum T, Xu Q, Joussen AM, et al. VEGF-initiated blood-retinal barrier breakdown in early diabetes. Invest Ophthalmol Vis Sci 2001;42:2408-13.

Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994;331:1480-7.

Adamis AP, Miller JW, Bernal MT, et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy. Am J Ophthalmol 1994;118:

-50.

Funatsu H, Yamashita H, Noma H, et al. Increased levels of vascular endothelial growth factor and interleukin-6 in the aqueous humor of diabetics with macular edema. Am J Ophthalmol 2002;133:70-7.

Funatsu H, Yamashita H, Ikeda T, et al. Angiotensin II and vascular endothelial growth factor in the vitreous fluid of patients with diabetic macular edema and other retinal disorders.Am J Ophthalmol 2002;133:537-43.

Cunningham ET Jr, Adamis AP, Altaweel M, et al. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology 2005;112:1747-57.

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.

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

Michels S, Rosenfeld PJ, Puliafito CA, et al. Systemic bevacizumab (Avastin) therapy for neovascular age-related macular degeneration. Twelve-week results of an uncontrolled openlabel

clinical study. Ophthalmology 2005;112:1035-47.

Avery RL, Pieramici DJ, Rabena MD, et al. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 2006;113:363-72.

Iturralde D, Spaide RF, Meyerle CB, et al. Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina 2006;26:279-84.

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulindependent diabetes mellitus. Diabetes Control and Complications Trial

Research Group. N Engl J Med 1993;329:977-86.

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998;317:703-13.

Strom C, Sander B, Klemp K, et al. Effect of ruboxistaurin on blood-retinal barrier permeability in relation to severity of leakage in diabetic macular edema. Invest Ophthalmol Vis Sci 2005;46:3855-8.

Campochiaro PA, C99-PKC412-003 Study Group. Reduction of diabetic macular edema by oral administration of the kinase inhibitor PKC412. Invest Ophthalmol Vis Sci 2004;45:922-31.

Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev 2004;25:581-611.

Mordenti J, Thomsen K, Licko V, et al. Intraocular pharmacokinetics and safety of a humanized monoclonal antibody in rabbits after intravitreal administration of a solution or a PLGA microsphere formulation. Toxicol Sci 1999;52:101-6.

Shahar JS, Avry RL, Heilweil G, et al. Electrophysiologic and retinal penetration studies following intravitreal injection of bevacizumab. Retina 2006;26:262-9.

Maturi RK, Bleau LA,Wilson DL. Electrophysiologic findings after intravitreal bevacizumab (Avastin) treatment. Retina 2006; 26:270-4.

Manzano RP, Peyman GA, Khan P, Kivilcim M. Testing intravitreal toxicity of bevacizumab (Avastin). Retina 2006;26: 257-61.

Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration.

Ophthalmic Surg Lasers Imaging 2005;36:331-5.

Haritoglou C, Kook D, Neubauer A, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina 2006;26:999-1005.

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2021-05-22

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