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Background: clinically significant macular edema ( CSME) consider as one of the most critical complications of poorly controlled diabetes and it’s the main reason for decreased vision in that kind of patients, we try in this article to find the relation between glycosylated hemoglobin level and the response to bevacizumab injections in people with macular edema Materials and methods: Ninety-five patients (55 male:40 female) were recruited in this study, all of them had diabetes type2, age of the participants ranging from 42 to 70 years old, Complete ophthalmic examination was done for all the participants including (best-corrected visual acuity), (intraocular pressure) checking, fundus evaluation, and central macular thickness measurement, serum glycosylated hemoglobin (HbA1C) was also measured, Patients were given 0.05ml(1.25mg) of bevacizumab (Avastin) intravitreally for three successive months, Follow up visit was at 4,8,12 week post-injection. On each follow up detailed examination was done including the( best-corrected visual acuity) examination, (Intraocular pressure), both fundus examination, and OCT of the macula. Results: This study included 111 patients who had type 2 diabetes mellitus who were classified according to HbA1c into two sub-groups, HbA1c ≤ 7 % (n = 45) and HbA1c > 7 % (n = 66) we found no significant difference in mean age and frequency distribution according to gender between study groups (p > 0.05), but, there was a highly significant difference in mean HbA1c % (p < 0.001). when we compare mean OCT and mean VA before and after the intervention in patients who had diabetes mellitus classified according to HbA1c into (HbA1c ≤ 7 % and HbA1c > 7 %) we found that before the intervention, there was no significant difference in mean OCT between study groups (p > 0.05), but after the intervention, there was a reduction in mean OCT and the reduction was more pronounced in the group of HbA1c of less than 7 % (p < 0.001). About visual acuity, we found no significant difference before the intervention and after the intervention, the changes were comparable between both study groups (p > 0.05). Conclusion: intra-vitreal injections of bevacizumab result in anatomical (macular thickness) and functional (vision ) improvement in those patients who had diabetic macular edema and strict glycemic control affecting the outcome of the treatment where strict regulation of glucose level have yield maximum benefit from the given therapy

Raffaele Nuzzi, Simona Scalabrin, Alice Becco Eye Clinic, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, ItalyCorrespondence: Raffaele NuzziEye Clinic of University of Turin, Turin, ItalyTel +39 0116337225Fax +39 0116335481Email prof.nuzzi_raffaele@hotmail.itPurpose: This study aims to evaluate the effectiveness of different decompressive injection techniques in reducing intraocular pressure (IOP) spikes, if compared to the injection without pressure applied on the eye, following the intravitreal injection of bevacizumab.Patients and Methods: Two hundred patients with indication to intravitreal therapy were randomized into five arms: 40 received intravitreal injection without ocular decompression (arm A), 40 with pre-injection scleral indentation with cotton swab (arm B), 40 with pre-injection digital ocular massage (arm C), 40 with post-injection scleral indentation with cotton swab (arm D) and 40 with post-injection digital ocular massage (arm E). All patients underwent measurement of the IOP with Goldamm applanation tonometer 10 minutes before and 10 minutes after the injection. The primary endpoint of the study was variation of the post- injection IOP with the different techniques.Results: An increase in post-injection IOP was observed in all the arms, if compared to pre-injection values. The greatest increase was observed in arm A with a mean IOP rise of 17.60 mmHg. All other techniques showed lower mean IOP increases: arm B 10.76 mmHg, arm C 9.35 mmHg, arm D 8.8 mmHg, arm E 3.4 mmHg. The post-injection IOP differences of innovative techniques compared to the technique without ocular decompression were all statistically significant (p-value < 0.01). If compared to arm A (35%), a reduction in IOP spike ≥ 40 mmHg frequency was also observed. The status of phakia/pseudophakia, a previous diagnosis of glaucoma and the underlying pathology for which indication was given to inject bevacizumab did not significantly alter the post-injection IOP in any of the protocols.Conclusion: The introduction of new injection protocols, such as injections performed before or after decompressive treatments, could be a safe and effective approach to control post-injection IOP increase.Keywords: bevacizumab injection, injection technique, intraocular pressure spike, digital ocular massage, scleral indentation, applanation tonometry

Objective: To evaluate the relationship of baseline Hemoglobin A1c (HbA1c) with visual, anatomical outcomes and frequency of cost effective bevacizumab at 12 months in eyes of diabetic macular edema (DME) in a developing country . Study Design: Retrospective cross sectional comparative data. Place and Duration of Study: Prevention of blindness (POB), Karachi, Pakistan between October 2018 and sept 2019. Methodology: It is a comparative cross sectional retrospective study. A total of 280 patients with DME presenting to the eye OPD of POB who did not receive any treatment before in the absence of concurrent retinal disease and treated with at least 3 intravitreal injections of bevacizumab and who completed the follow-up of 12 months included in the study. Results: There were 280 patients , male were 149 (53.2%) and female 131 (46.8%), 95% patients age 50 years. Patients divided into 3 groups n= 20 (7.1%) , 187 (66.8%) and 73 (26.1%) patients with Hba1c 8.0 respectively. Central macular thicknesss decreased significantly from baseline in all 3 groups with vision improved the most in group 1

This case report describes full-thickness macular hole formation after intravitreal aflibercept injections for the treatment of macular neovascularization in neovascular age-related macular degeneration (AMD). Only limited case reports and case series have reported this possible adverse event after aflibercept injection. Possible mechanisms leading to the formation of a macular hole subsequent to intravitreal injection are focal tractional forces on the vitreoretinal interface due to globe deformation during needle insertion, vitreous syneresis, and vitreous incarceration at the injection site, and tangential shearing forces on the posterior surface of the retina due to contraction and rapid volume reduction of the neovascular membrane or a decrease in intra- or subretinal fluid. Furthermore, some reports suggest a toxic effect of the anti-vascular endothelial growth factor agent on a previously compromised retina as etiological factor. Macular hole formation may thus represent a rare adverse event of intravitreal aflibercept injection in patients with neovascular AMD, and it should be included in the differential diagnosis of post-injectional visual loss. ispartof: CASE REPORTS IN OPHTHALMOLOGY vol:13 issue:1 pages:247-252 ispartof: location:Switzerland status: published

Purpose to compare between recurrence incidence after primary pterygium excision when using preoperative subconjunctival injection of Bevacizumab (Avastin) and using it as a postoperative eye drops. Methods thirty two eyes of thirty patients (two patients had bilateral pterygium) with primary pterygia were clinically examined, classified into 3 groups and operated by simple excision with bare sclera technique. Group 1 included 10 patients received Bevacizumab (Avastin) in the form of eye drops (10 mg/ml) 3 times daily for 6 days postoperative. Group 2 included 10 patients received preoperative Bevacizumab in the form of subconjunctival injection (1.25 mg/0.05ml) single dose 1 week preoperative. Group 3 included 10 patients (12 eyes) 2 patients with bilateral Pterygium didn’t receive any form of Bevacizumab. Postoperative follow up was done clinically and by serial photography at 1 week, 1 month, 3 months and 6 months searching for signs of recurrence and/or complications. Results The results showed different grades of recurrence in 18 eyes of 32.True recurrence was seen in 7 patients of 18 (1 patient in group 1, 2 in group 2 and 4 in group3).Recurrence grades in group 1and 2 who used the Bevacizumab (20%grade II, 50% grade III, and 30% grade IV). Recurrence could be predicted by 100% depending on fibrovascular tissue appearing in the surgical bed at 3 months postoperative (P value 0.038).Preoperative fleshy pterygium has high statistical significance in realation to recurrence(P value = 0.006).Patient’s sex, residence and occupation had no statistically significant value in the process of recurrence (P value > 0.05). Patients with recurrent Pterygia (in group 1&2) had statistically significant changes in the corneal K- readings at 3 months and 6 months.No significant difference in the limbal or central corneal thickness in the operated eye and the other eye (Pvalue > 0.05). Conclusion Bevacizumab (Avastin) is a well tolerated drug with multiple drug delivery methods.The eye drops give better results than the subconjunctival injection.Appearance of fibrovascular tissue in the surgical bed at 3 months predict the recurrence by 100%. Preoperative fleshy pterygia will mostly recur again whatever Bevacizumab form was used .The corneal thickness by anterior segment OCT has no role in prediction or detection of early pterygium recurrence.

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

Purpose: To evaluate the effect of intra-vitreal bevacizumab in macular edema caused by branch retinal vein occlusion. Study Design: Interrupted time series study. Place and Duration of Study: Department of Ophthalmology Hayatabad Medical Complex, Peshawar and department of Ophthalmology Lady Reading Hospital Peshawar from 1st July 2016 to 31st December 2016. Material and Methods: There were 60 patients included in the study. All patients with macular edema due to BRVO visible clinically and evident on SD-OCT and visual acuity of less than 6/9 were included in the study. Patients who used other intra-vitreal drug for macular edema, those with surgery in the same eye and those with macular laser for macular edema were excluded from the study. All patients were given intra-vitreal 0.05 ml bevacizumab injection every month for 6 months. After 6 months OCT was repeated. At each monthly visit VA was measured and fundoscopy was done. Follow up of all patients was at six months. Results: Our study included 60 patients with mean age of 54.42 ± 9.19 years. The mean baseline central macular thickness was 427.06 µ with SD ± 63.54 µ. After 6 months significant improvement in visual acuity was documented. Also marked reduction in central macular thickness was noted after six months with mean of 327.44 µ with SD ± 55.55 µ. Conclusion: Intra-vitreal bevacizumab is an effective treatment for macular edema caused by BRVO in terms of both anatomic and visual improvement. Key words: Branch retinal vein occlusion, bevacizumab, macular edema.

Purpose To evaluate the short-term results of sub-tenon's injection of bevacizumab in patients with clinically significant macular edema (CSME). Methods In this prospective non-comparative interventional case series, sub-tenon's injection of 2.5mg/0.1ml bevacizumab was performed for eyes with CSME. Macular thickness and best corrected visual acuity measurements were performed before and one month after injections. Results Nineteen eyes of twelve patients with a mean age of 59.8±5.7years were evaluated. Thirteen eyes (68.4%) had center-involving macular edema. No significant difference was observed between pre- and post-injection central subfield retinal thickness measurements ( P =0.3). Central subfield thickness measurements improved or remained unchanged in 13 eyes (68.4%). Baseline BCVA of 0.48±0.35 LogMAR improved to 0.36±0.26 LogMAR after injection ( P =0.01). Improvement of>2 lines in BCVA was found in 5 eyes (26.3%), and no eye lost>2 lines of BCVA. No complication associated with sub-tenon's injection was observed. Conclusion Sub-tenon's injection of bevacizumab resulted in significant short-term visual improvement in eyes with CSME. Retinal thickness changes were not significant.

PURPOSE To analyze the predictive ability of quantitative reduction in central foveal thickness (CFT) after the first antivascular endothelial growth factor (anti-VEGF) injection to assess final outcome in branch retinal vein occlusion (BRVO) patients. DESIGN A retrospective interventional consecutive case series. METHODS We retrospectively reviewed 60 treatment-naive BRVO patients. All the patients were treated with bevacizumab injection pro re nata. We measured the reduction in CFT 1 month after injection and at each visit along with other optical coherence tomography (OCT) features like external limiting membrane (ELM) integrity, ellipsoid zone (EZ) integrity, and foveal bulge (FB). RESULTS At final follow-up more patients in the >25% CFT reduction group had a better mean best-corrected visual acuity (BCVA) and dry macula as compared with the ≤25% group (0.25 logMAR vs 0.46 logMAR, P = 0.03; 28 eyes vs 9 eyes, P = 0.005). Based on the final visual outcome we divided patients into 2 groups: group 1, BCVA ≥ 20/40; group 2, BCVA

Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV). However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior. A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections. Six months postoperatively, there was significant regression of the neovascular area and vessel caliber. Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection. The findings may suggest a new prospect in treating corneal NV.

Purpose The aim of this study was to compare subconjunctival bevacizumab injection and mitomycin C (MMC) application after primary pterygium surgery in terms of recurrence rates and complications. Patients and methods This prospective comparative clinical study included 90 eyes of 90 patients with primary pterygium who underwent excision with bare sclera technique. Patients were randomized into three groups: group A (30 eyes), in which MMC 0.02% was applied to the bare scleral area for 3 min; group B (30 eyes), which received 2.5 mg/0.1 ml subconjunctival bevacizumab injection at the end of surgery; and group C (30 eyes), which was used as a control group and did not receive any adjuvant medications after pterygium excision. Patients were followed up for 6 months, and the recurrence rates of pterygium and any complications were reported. Results At 6 months after surgery, the recurrence rates in the three groups were as follows: two (6.7%) eyes in the MMC group A, two (6.7%) eyes in the bevacizumab group B, and 11 (36.7%) eyes in the control group C, with a significant difference among groups (P=0.01). No serious complications, except subconjunctival hemorrhage, were observed in all groups. Conclusion Groups receiving topical 0.02% MMC and 2.5 mg/0.1 ml subconjunctival bevacizumab injections after surgery showed lower recurrence rates than the control group. However, no difference in the recurrence rate was observed between both groups.

Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity. Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection. Results. Mean followup was 14.1 months ± 7 . 1 (range: 5 to 24 months). Mean logMAR vision at baseline was 1.38 logMAR ± 0 . 3 3 , at 6 months was 1.14 logMAR ± 0 . 3 7 ( 𝑃 = 0 . 0 0 1 ) and at 12 months was 1.22 logMar ± 0 . 3 3 ( 𝑃 = 0 . 0 0 4 ). Mean baseline central retinal thickness was 431 μm ± 1 5 9 . 7 at 6 months was 293.43 μm ± 1 2 2 . 7 9 ( 𝑃 = 1 0 − 4 ) and at 12 months was 293.1 μm ± 1 3 0 ( 𝑃 = 0 . 0 0 4 ). Visual acuity improved in both patients with or without prior PDT treatment. Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.

Purpose: The author report the result of three consecutive monthly intravitreal ranibizumab injection for choroidal neovascularization (CNV) after bevacizumab injection for chronic central serous rethinopathy (CSR). Methods: A 48 year old man with chronic CSR was treated with intravitreal single dose 2.5 mg bevacizumab. One year after CNV was occurred, and three consecutive monthly intravitreal ranibizumab injections were performed. Results: Four weeks later the first ranibizumab dose, best corrected visual acuity was improved 20/80 to 20/20 and remained stable within one year. Conclusion: Repeat intravitreal ranibizumab injection in CNV after bevacizumab injection for chronic CSR appeared to be an effective treatment option.

Purpose To evaluate long-term outcomes and identify prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma. Methods Sixty-one eyes of 54 patients with neovascular glaucoma treated by trabeculectomy following intraocular bevacizumab injection were consecutively enrolled. Surgical success criteria were sufficient intraocular pressure (IOP) reduction (IOP ≤21 mmHg, ≥20% IOP reduction, no additional medications or glaucoma surgeries) without devastating complications (loss of light perception, phthisis bulbi, and endophthalmitis) or significant hypotony (IOP ≤5 mmHg continued ≥6 months and until the last follow-up visit or hypotony requiring intervention). Kaplan-Meier survival curves and Cox regression analysis were used to examine success rates and risk factors for surgical outcomes. Results The follow-up period after trabeculectomy was 45.0 ± 22.2 months (mean ± standard deviation). Surgical success rate was 86.9 ± 4.3% (± standard error), 74.0 ± 6.1%, and 51.3 ± 8.6% at 1, 3, and 5 years. Multivariate Cox regression analysis identified two risk factors; lower preoperative IOP (≤30 mmHg) for surgical failure and hypotony [hazard ratio (HR), 2.92, 6.64; 95% confidence interval (CI), 1.22 to 7.03, 1.47 to 30.0; P = 0.018, 0.014, respectively], and vitrectomy after trabeculectomy for surgical failure with or without hypotony criteria (HR, 2.32, 4.06; 95% CI, 1.02 to 5.28, 1.30 to 12.7; P = 0.045, 0.016, respectively). Conclusions The long-term outcomes of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma were favorable. Lower baseline IOP was associated with development of significant hypotony, while additional vitrectomy was related to insufficient IOP reduction.

We present the effect of pneumatic displacement therapy used along with intravitreal tissue plasminogen activator (t-PA) and bevacizumab injection in the treatment of massive submacular hemorrhage associated with exudative age-related macular degeneration. Sequential intravitreal injections of bevacizumab (0.05 ml) and t-PA (50 μgr in 0.1 ml) with pneumatic displacement were performed in a patient with submacular hemorrhage related to choroidal neovascular membrane. Submacular hemorrhage was totally displaced extramacularly after one week from the triple procedure and no complications were noted. Visual acuity was improved one week after treatment. Our findings demonstrated that intravitreous injections of bevacizumab, t-PA, and gas are effective and safe procedures that can improve and accelerate visual recovery in age-r elated macular degeneration patients with submacular hemorrhage, although final visual outcome is often limited by the progression of the underlying pathology. (Turk J Ophthalmol 2011; 41: 49-51)

Objective: To determine the clinical effect of subconjunctival injection of bevacizumab in regression or halting growth in patients with recurrent pterygium.Method and materials: The study was an off-label; 2-dosing, interventional case series involving 20 patients with recurrent pterygium. They received subconjunctival bevacizumab (0.2 ml/2.5 mg). Vascularity and thickness of Pterygium was graded. Size of the pterygium (measured by surface area in cm2) was recorded from baseline to 6 months, after injection. Treatment-related complications and adverse events were reported. The main outcome of measurements was the change in grading, size, vascularity, thickness and color intensity.Results: 9 males (45%) , 11 females (55%) of 20 patients were conducted in study with a mean age of 50.46 years ± 18.30 (rang 38-70). There was a significant reduction in grading with significant difference in the mean surface area of pterygium at different intervals (P

Purpose To evaluate the effect of subconjunctival bevacizumab injections in patients with corneal neovascularization resulting from different ocular surface disorders. Methods Prospective case series. Fourteen eyes of 13 patients with corneal neovascularization caused by different ocular surface disorders, such as healed corneal ulcers, long-standing chronic inflammatory diseases and corneal ischaemia secondary to burn were included. All eyes received a single subconjunctival injection of 2.5 mg (0.1 ml) bevacizumab. Morphological changes in neovascularization were evaluated during 3 months using slit-lamp biomicroscopy, corneal digital photography, and computed-assisted semi-automatic analysis of corneal neovascularization area. Results Recession of corneal vessels was observed in all eyes at 1 week post-injection. The surface of the neovascular tree continued to decrease noticeably for one month and then increased again for the remainder of the follow-up period. The corneal neovascularization area amounted to 12.14± 4.38% of the corneal surface pre-injection, compared with 9.10± 3.16% post-injection (p=0.02), reflecting a mean decrease in corneal neovascularization of 25 %. No local or systemic adverse events possibly related to subconjunctival bevacizumab injection were observed. Conclusion Short-term results suggest that subconjunctival bevacizumab can be used safely and effectively for corneal neovascularization resulting from different ocular surface disorders, providing an additional strategy to improve success of corneal grafts.

P William Conrad, David N Zacks, Mark W JohnsonDepartment of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USAPurpose: To determine whether the effect of a single initial intravitreal injection of bevacizumab for neovascular age-related macular degeneration (AMD) persists for 8 weeks.Methods: We reviewed the records of 25 consecutive patients with neovascular AMD treated with intravitreal bevacizumab. Patients were included (n = 15) if follow up data were available from 4 and 8 week visits after a single initial injection. Additionally, optical coherence tomography (OCT) images were graded qualitatively in a masked fashion by a single reader.Results: Baseline mean visual acuity was 20/200, improving to 20/125 at 4 weeks (p = 0.0153) and 20/100 at 8 weeks (p = 0.0027). Mean central retinal thickness was 316 ± 107 µm at baseline and decreased to 223 ± 70 µm and 206 ± 45 µm at 4 and 8 weeks post-injection, respectively (p = 0.0003 and 0.0005). By masked OCT grading, macular fluid was resolved in 10/15 (66.7%) and 11/15 (73.3%) eyes at 4 and 8 weeks, respectively, and 3/15 (20%) eyes had continued reduction in residual macular fluid between 4 and 8 weeks.Conclusions: A single initial bevacizumab injection has persistent clinical benefit lasting 8 weeks in most eyes with neovascular AMD. Results of prospective randomized studies are needed before changes in treatment regimens can be recommended.Keywords: age-related macular degeneration, bevacizumab, choroidal neovascular membrane, optical coherence tomography

Objective The aim of this study was to evaluate the safety and the efficacy of subconjunctival injection of bevacizumab (Avastin) for the management of primary and recurrent pterygia and to estimate the recurrent rate of pterygia after surgery. Patients and methods The study included 60 eyes of 60 patients (45 male and 15 female), with a mean age of 41 ± 4.8 years. Forty patients (66.6%) had primary pterygia and the remaining 20 patients had recurrent pterygia after a previous surgery. A preoperative injection of bevacizumab was given at a dose of 1.25 mg (0.05 ml) 1 week before pterygium surgery was performed using the conjunctival flap technique. Twenty patients were enrolled as a control group and they were operated upon without preoperative bevacizumab injection. Mitomycin C (0.1 mg/ml) was used intraoperatively in recurrent cases. All patients were followed up for 3-6 months. Results Most of the patients (48.3%) had grade 2 pterygium. The average time for each procedure was 30 ± 15 min. No patient lost vision after the procedure. Recurrence was noted in five patients (8.3%), and all of them had primary pterygia. Conjunctival graft rejection occurred in three patients (5%); this graft rejection occurred in recurrent pterygia. Postoperative conjunctival vascularization occurred in four patients (6.7%), and this vascularization occurred in the recurrent cases. A significant improvement of visual acuity and corneal clearance was noticed in all patients. Conclusion Preoperative subconjunctival injection of bevacizumab reduces the recurrence rate of pterygium surgery as it reduces the vascular element of the pterygium. Intraoperative application of mitomycin C in addition to preoperative subconjunctival injection of bevacizumab reduces recurrence in recurrent pterygium cases. Further long-term, large-scale studies are recommended.

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

We evaluated the effect of intravitreal bevacizumab (IVB) injection before pars plana vitrectomy (PPV) on intravitreal hemorrhage (VH) during and after vitrectomy for postoperative the first day and the first month in pseudophakic patients with proliferative diabetic retinopathy (PDR). This retrospective study was performed on 44 eyes of 44 patients who underwent vitrectomy for PDR. Patients were divided into PPV (n = 22 eyes) and PPV + IVB (n = 22 eyes) groups. Injection of bevacizumab (1.25 mg/0.05 mL) was performed 3 days before vitrectomy. Outcomes of visual acuity as well as intraoperative and postoperative VH were compared between the two groups. One month after surgery, visual acuity improved in PPV and PPV + IVB groups ( P = 0.005, P = 0.006), respectively. There was no difference between the two groups in best corrected visual acuity at baseline and after vitrectomy ( P = 0.71). Intraoperative bleeding into the vitreous was recorded in 14 (63.6%) cases in the PPV group and in 7 (31.8%) cases in the PPV + IVB group. The first month, intravitreal hemorrhage was recorded in six patients in the PPV group and in two patients in the PPV + IVB group ( P = 0.03). The mean pre-postoperative central macular thickness was similar in both groups. Intravitreal injection of IVB before vitrectomy decreased the rate of VH at the time of surgery and at the first postoperative month in patients with PDR.

Objectives To determine the effects of intraocular pressure (IOP) and needle diameter on the amount of reflux after intravitreous bevacizumab injection. Methods Prospective randomized interventional study. Twelve New Zealand white rabbits weighing approximately 2.5 to 3.5 kg each were randomized 1:1 to group 1 or group 2. Bevacizumab stained with trypan blue was used for intravitreous injection. To lower the IOP, eyes in group 2 underwent anterior chamber paracentesis before intravitreous injection. Two eyes in each group were injected using 27-, 30-, or 32-gauge needles. If a subconjunctival bleb formed after intravitreous injection, its diameter was measured using a caliper. Results The median IOP in group 1 was 17.5 mm Hg. Eyes injected using 27-gauge and 30-gauge needles showed stained subconjunctival blebs with median sizes of 3 mm and 1.7 mm, respectively; eyes injected using 32-gauge needles showed no subconjunctival bleb formation. The median IOP in group 2 was 10.3 mm Hg. Eyes injected using 27-gauge needles showed stained subconjunctival blebs with a median size of 0.7 mm, and eyes injected using 30-gauge and 32-gauge needles showed no subconjunctival bleb formation. Conclusion Decreasing the IOP before intravitreous injection and using a smaller-gauge needle reduce the risk of drug reflux after intravitreous bevacizumab injection. Clinical Relevance Intravitreous injection is an increasingly common route of drug delivery to treat ocular diseases. Techniques that maximize bioavailability are examined in this study.

PURPOSE. To test the long-term effects and systemic exposure level after single or multiple bevacizumab (Avastin) intravitreal injections in newborn rabbit eyes. METHODS. Four groups of newborn New Zealand rabbits received a single intravitreal bevacizumab injection at a concentration of 1.25 mg/0.05 mL at the ages of 2 (group 1), 4 (group 2), 6 (group 3), and 12 (group 5) weeks. The other group of rabbits (group 4) received three consecutive injections of bevacizumab at a concentration of 1.25 mg/0.05 mL at weeks 2, 6, and 10. Eight days after injection, the serum concentration of bevacizumab was determined in groups 1, 2, 3, and 5. Morphologic and functional changes were evaluated 12 months after bevacizumab injection. RESULTS. Twelve months after either single or multiple intravitreal injections of bevacizumab, newborn rabbit eyes showed no significant differences compared with control eyes on examination with funduscopy, histopathology, or electroretinogram. The serum concentrations when the injections were performed at the ages of 2 (19.4 +/- 8.1 microg/mL) and 4 (10.2 +/- 2.3 microg/mL) weeks were significantly higher than the serum level detected when the injection was performed at 12 weeks of age (2.8 +/- 1.2 microg/mL, P = 0.02 and P = 0.024, respectively). CONCLUSIONS. After 1 year, single and three consecutive intravitreal injections of 1.25 mg bevacizumab in newborn rabbit eyes are well tolerated. Systemic exposure is higher when the injection is performed at an early age.

Purpose: To compare intraocular pressure (IOP) changes after intravitreal triamcinolone acetonide versus bevacizumab injection. Methods: IOP was measured in 40 patients who received an intravitreal injection of 0.1 ml triamcinolone and 40 patients who received 2 consecutive intravitreal injections of bevacizumab (0.05 ml and 0.1 ml). Patients were divided into three groups : 0.1 ml triamcinolone group (0.1 IVTA group), 0.05 ml bevacizumab group (0.05 IVB group), and 0.1 ml bevacizumab group (0.1 IVB group). IOPs were compared within groups at different time points (before, 1 day after, and 30 days after the injection) and between groups at the same time points. Results: In the 0.05 IVB and 0.1 IVB groups, IOP at 1 day after injection was significantly lower than before injection (P

Purpose: To compare clinical outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of macular edema secondary to branch retinal vein occlusion. Methods: Sixty-six patients received an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed. Thirty-three out of 66 patients were treated with an intravitreal injection of triamcinolone acetonide, while the other 33 patients received a bevacizumab injection. All patients underwent a visual acuity test, optical coherence tomography imaging and ophthalmoscopic examination throughout the follow-up. Results: In the triamcinolone group, central macular thickness (CMT) decreased from 496.69 153.01 at baseline to 313.06 150.14 at the six-month follow-up visit, while in the bevacizumab group, CMT decreased from 441.30 185.79 to 295.67 188.80 (p 0.70 at baseline to logMAR 0.53 0.43 at the six-month follow-up visit, and in the bevacizumab group, BCVA improved from logMAR 0.74 0.47 to logMAR 0.34 0.33 (p

Purpose: To compare central macular thickness (CMT) and visual acuity outcomes after intravitreal injection of triamcinolone acetonide or bevacizumab for the treatment of diabetic macular edema (DME). Methods: Fifty-one patients were randomly choosen to receive an intravitreal injection of either triamcinolone acetonide or bevacizumab. Patients were retrospectively reviewed, and 28 of 51 received an intravitreal injection of triamcinolone acetonide while the remaining 23 received bevacizumab injection. All patients underwent Snellen visual acuity testing, optical coherence tomography imaging and ophthalmoscopic examination at baseline and at four weeks following the injection. Results: In the triamcinolone group, CMT decreased from 656.71 at baseline to 312.46 at the four-week follow-up visit, while in the bevacizumab group, CMT decreased from 582.17 at baseline to 453.09 at the follow-up (p0.38 to 0.670.33) compared to the bevacizumab group (from 0.790.31 to 0.700.34) [p

Purpose: To clinically establish the effectiveness and safety of bevacizumab on recurrent pterygium. Methods: Twenty patients with recurrent pterygium were given a subconjunctival injection of 0.3 cc bevacizumab, and were evaluated for periodic clinical results at 1 week, 2 weeks, 4 weeks, and every month thereafter. The patients were also evaluated for clinical results and complications. Results: Of recurrent pterygium patients with bevacizumab injection, the conjunctival injection decreased maximally after 1 to 2 weeks, but significantly increased at 4 weeks (above the lowest level measured at 1 to 2 weeks), and no patient presented conjunctival injection above the pre-injection level at 3 months, except in 2 cases. Two weeks after the injection, ICG anterior segment angiography revealed a significant decrease (30.14+17.69%) in vessel thickness of the pterygium 2 weeks after the bevacizumab injection compared to before the injection. There had been no cases of progression of pterygium, and no ocular or systemic complications due to bevacizumab. Conclusions: As shown above in the results, subconjunctival injection of 0.3 cc bevacizumab decreased the conjunctival injection and effectively suppressed any further progression of pterygium. Thus, bevacizumab subconjunctival injection appears to be effective in recurrent pterygium treatment instead of surgical methods.

Purpose: Scarring after glaucoma filtering surgery remains the most frequent cause for bleb failure. The aim of this study was to assess if the postoperative injection of bevacizumab reduces the number of postoperative subconjunctival 5-fluorouracil (5-FU) injections. Further, the effect of bevacizumab as an adjunct to 5-FU on the intraocular pressure (IOP) outcome, bleb morphology, postoperative medications, and complications was evaluated. Methods: Glaucoma patients (N = 61) who underwent trabeculectomy with mitomycin C were analyzed retrospectively (follow-up period of 25 ± 19 months). Surgery was performed exclusively by one experienced glaucoma specialist using a standardized technique. Patients in group 1 received subconjunctival applications of 5-FU postoperatively. Patients in group 2 received 5-FU and subconjunctival injection of bevacizumab. Results: Group 1 had 6.4 ± 3.3 (0–15) (mean ± standard deviation and range, respectively) 5-FU injections. Group 2 had 4.0 ± 2.8 (0–12) (mean ± standard deviation and range, respectively) 5-FU injections. The added injection of bevacizumab significantly reduced the mean number of 5-FU injections by 2.4 ± 3.08 (P ≤ 0.005). There was no significantly lower IOP in group 2 when compared to group 1. A significant reduction in vascularization and in cork screw vessels could be found in both groups (P < 0.0001, 7 days to last 5-FU), yet there was no difference between the two groups at the last follow-up. Postoperative complications were significantly higher for both groups when more 5-FU injections were applied. (P = 0.008). No significant difference in best corrected visual acuity (P = 0.852) and visual field testing (P = 0.610) between preoperative to last follow-up could be found between the two groups. Conclusion: The postoperative injection of bevacizumab reduced the number of subconjunctival 5-FU injections significantly by 2.4 injections. A significant difference in postoperative IOP reduction, bleb morphology, and postoperative medication was not detected.