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Faiz I Shakarchi,1,2 Ahmed F Shakarchi,3 Shadha A Al-Bayati2 1Department of Ophthalmology, Al-Mustansiriya University – College of Medicine, Baghdad, Iraq; 2Vitreoretinal Department, Ibn Al-Haetham Teaching Eye Hospital, Baghdad, Iraq; 3Baghdad Teaching Hospital, Baghdad, Iraq Purpose: To determine the timing of neovascular regression after intravitreous injection of bevacizumab (Avastin®) 1.25 mg given as initial therapy for eyes with high-risk proliferative diabetic retinopathy (PDR) without clinically significant macular edema (CSME). Patients and methods: In this prospective uncontrolled interventional study, eyes with high-risk PDR without CSME were treated initially with intravitreous injections of bevacizumab 1.25 mg given every 4 weeks until no neovessels were detected, followed by standard pan-retinal photocoagulation (PRP). Patients were examined 48 hours, 1, 2, and 4 weeks after each injection to determine the status of neovascularization. Results: Twenty-one patients (24 eyes) were included in the study. Forty-eight hours after the first injection of bevacizumab, we observed complete neovascular regression in 20 (83%) eyes. Neovascular regression was maintained in the same number of eyes in the first 2 weeks. At 4 weeks, three eyes displayed neovascular recurrence, and a second injection of bevacizumab was given to the seven eyes with persistent or recurrent neovascularization. Complete neovascular regression was observed in six (86%) eyes after 48 hours and was maintained for 2 weeks following the second bevacizumab injection. Two eyes required a third injection and had complete neovascular regression when assessed after 48 hours and 4 weeks. Conclusion: The majority of neovessels completely regressed within 48 hours after intravitreous injection of bevacizumab given as initial therapy for high-risk PDR without CSME. The full neovascular regressive effect occurred within 48 hours and was maintained for at least 2 weeks. Keywords: proliferative diabetic retinopathy, anti-vascular endothelial growth factor (anti-VEGF), bevacizumab

To evaluate the effect of anti-VEGF (bevacizumab) injection to the posterior chamber (BIPC) behind the iris combined with seton implantation in treatment of neovascular glaucoma (NVG).Twenty-eight eyes with NVG who underwent BIPC, prospectively evaluated. Anterior segment photographs were taken for grading of neovascularization on anterior segment in pretreatment period and at each follow-up. Grading and regression of rubeosis iridis was classified according to Teich and Walsh grading system and glaucoma filtration surgery with drainage device was performed following BIPC.The mean pre-BIPC IOP was 39.71 ± 7.09 mmHg, post-BIPC IOP in the 1st, 2nd day, 1st week, 1st, 3rd, 6th month were 19.7 ± 8.9 mmHg, 13.5 ± 6.7 mmHg, 9.9 ± 3.4 mmHg, 13.07 ± 5.3 mmHg, 16.6 ± 5.03 mmHg, 18.5 ± 3.8 mmHg, respectively. Twenty seven eyes underwent seton implantation surgery. No one had anterior segment bleeding during surgery. The pre-BIPC grades were Grade 4: 67.58%, Grade 3: 28.57%, Grade 2: 3.57%, no one had Grade 1or Grade 0, while post BIPC grade were at the 1st week Grade 1: 64.28%, Grade 0: 35.71%, no one had Grade 2 or more, at 1st month Grade 2: 3.57%, Grade 1: 39.28%, Grade 0: 57.14%, at 3rd month Grade 2: 17.85% Grade 1: 28.57%, Grade 0: 53.57%, no one had Grade 3 or more both in first and the third month, at 6th month Grade 3: 7.14%, Grade 2: 28.57%, Grade 1: 42.85%, Grade 0: 21.42%. and no one had Grade 4.Significant reduction of NV was observed during the first week. Minimal increasement was seen in third month, significant regression effect persisted for 6 months. BIPC inhibited the peroperative risk of anterior segment bleeding, increased the surgical comfort and prevented the failure of filtration procedure by inhibiting reproliferation.

We report on the use of subconjunctival bevacizumab on corneal vessel density in recurrent pterygia.The charts of 5 patients with recurrent pterygium, who received subconjunctival injections of bevacizumab (2.5 mg/0.1 ml) were retrospectively reviewed. Ophthalmic evaluation included Snellen visual acuity (VA), tonometry and complete examination before the injection and at 1 week and 1 and 3 months thereafter. Digital photographs of the eyes were analyzed by image analysis software to determine the area of cornea covered by new vessels as a percentage of the total corneal area.No ocular or systemic adverse events were observed. No change in visual acuity was noted in any patient following the injection. The mean change in corneal vascularization after one bevacizumab injection was 0.03%+/-0.45, while after two injections the change was 0.025%+/-0.19 (both not statistically different than zero, t-test).Short-term results suggest that subconjunctival bevacizumab is well tolerated but does not cause regression of corneal vessels in recurrent pterygium.

Ahmed M SaeedDepartment of Ophthalmology, Benha University, Benha, EgyptBackground: The purpose of this study was to compare the safety and efficacy of combined vitrectomy, intravitreal triamcinolone acetonide (IVTA), and bevacizumab injection with that of IVTA and bevacizumab injection and subsequent macular grid laser photocoagulation for the treatment of intractable diffuse diabetic macular edema.Methods: This randomized controlled clinical trial was performed at Benha University Hospital, Benha, Egypt, and included 34 eyes from 34 diabetic patients diagnosed with intractable diffuse diabetic macular edema without vitreomacular traction. The patients were divided into two groups. In group 1, pars plana vitrectomy with removal of the posterior hyaloid was performed, and at the end of the procedure, IVTA 0.1 mL (40 mg/mL) and bevacizumab 1.25 mg were injected. In group 2, macular grid laser photocoagulation was performed 2 weeks after the same intravitreal injection combination as used in group 1. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness, which were measured using optical coherence tomography at 3, 6, and 12 months.Results: Changes in BCVA and central foveal thickness at 3, 6, and 12 months from baseline were highly statistically significant (P < 0.01). Mean BCVA was better in group 1 at 3 months, nearly equal at 6 months, and less at 12 months. Mean central foveal thickness was more improved in group 1 than in group 2 at 3 months, and was better in group 2 at subsequent measurement points. The major adverse events were development of cataract (more common in group 1) and elevation of intraocular pressure (more common in group 2).Conclusion: The combined therapy described here could represent a solution for the treatment of intractable diabetic macular edema, and could have a favorable long-term outcome. Combined treatment of IVTA and bevacizumab plus grid laser resulted in a more favorable reduction in central foveal thickness and improvement in BCVA at 12 months than vitrectomy combined with the same injections. This small study favors the safer, cheaper, and more available line of treatment.Keywords: intractable diffuse diabetic macular edema, intravitreal triamcinolone, bevacizumab injection, macular grid laser photocoagulation, central foveal thickness