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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

Objectives: The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice. Methods: A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Sublesional bevacizumab injection was used based on joint patient-physician decision making. Papilloma burden was objectively measured on prior recordings by 2 blinded reviewers and described as vocal fold segments affected (VFSA) by papilloma. Each patient served as their own control by comparing times when bevacizumab was or was not used. Mixed model for longitudinal data was used to determine if the previous use of bevacizumab decreased the disease burden. Results: A total of 19 patients met inclusion criteria and all prior laryngoscopic exams were reviewed for VFSA as described above. The mean (SD) number of VFSA when bevacizumab was not used at the prior procedure was 15 (14) as compared to 8 (11) when bevacizumab was used. When adjusted for age, time from initial presentation and baseline disease burden, mixed model showed a decrease of 11 VFSA (95% CI 6.5, 15.5, P Conclusion: Using sublesional bevacizumab intermittently based on clinical findings appears to be effective in improving disease control. Papilloma burden is significantly decreased at the subsequent clinical follow-up following injection of sublesional bevacizumab. The beneficial effect of sublesional bevacizumab may be not be dose-dependent.

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

To determine the efficacy of subconjunctival bevacizumab injection after pterygium excision with limbal conjunctival autograft and limbal fixation suture. This retrospective study included a total of 150 eyes of 150 patients with primary pterygium who received three different procedures after pterygium excision, i.e., 49 eyes with limbal conjunctival graft (group A), 48 eyes with limbal conjunctival autograft with limbal fixation suture (group B), and 53 eyes with limbal conjunctival autograft with limbal fixation suture followed by bevacizumab injection (group C). Image analysis was performed using preoperative anterior segment photographs to measure parameters including relative length, relative width, relative area, and vascularity index of pterygium. Recurrence of pterygium was determined at 1 year after surgery, and outcomes were compared between the 3 groups. Risk factors related to recurrence were evaluated using univariate and multivariate analyses. Recurrence rates after 1 year were 18.4% (9/49), 8.3% (4/48), and 1.9% (1/53) in groups A, B, and C, respectively (P = 0.004). Multivariate analysis showed that patients in group C had significantly reduced risk of recurrence compared with those in group A (P = 0.009), whereas the risk of recurrence was not significantly different between groups A and B (P = 0.227) and groups B and C (P = 0.068), respectively. Among various parameters, higher vascularity index had significant correlation with increased risk of recurrence (P = 0.008). Bevacizumab injection after limbal conjunctival autograft and limbal fixation suture may effectively reduce recurrence after pterygium excision. The vascularity of pterygium was associated with a higher risk of recurrence.

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

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

IMPORTANCE The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. BACKGROUND Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. DESIGN Prospective and randomized clinical trial. PARTICIPANTS Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. METHODS In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization MAIN OUTCOME MEASURES: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. RESULTS Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88 ± 7.62 mmHg in group 1 and 27.52 ± 8.57 mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42 ± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP ≤ 21 mmHg with at least 20% reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP ≤ 18 mmHg The cumulative success according to criterion A and B was 77.8%, 72.2% in group 1 and 89.5% in group 2, respectively, at the end of follow-up. CONCLUSIONS AND RELEVANCE Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up.

Background: anti-vascular endothelial growth factor (anti-VEGF) has been suggested for the treatment of macular edema. In this study we are assessing the efficacy of one type of anti-vascular endothelial growth factor which is Bevacizumab (Avastin) in the reduction of macular thickness. Patients and Methods: from the period of February 2012 to February 2015, we have gathered the data of 54 patients (39=males, 15 =females) suffering from macular edema who received variable number of intraocular injections of Bevacizumab to be included in a retrospective study. One eye from each patient was chosen randomly and then we observe their follow-up Optical Coherence Tomography (OCT) for any changes in the thickness of the macula. Results: after receiving a single Bevacizumab injection, 16 patients (29.6%) did not show any improvement while 22 (40.7%) patients show an improvement that was less than 50 microns of reduction in magnitude, 5 patients (9.2%) showed an improvement that was greater than 50 microns in reduction of macular thickness and the remaining 11 patients (20.3%) had a reduction of macular thickness that was greater than 100 microns. Conclusion: despite being used originally for metastatic colon cancer, Bevacizumab (Avastin) can be used in the treatment of diabetic macular edema.

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 efficacy and safety of Ex-PRESS mini glaucoma shunt implantation with preoperative intracameral bevacizumab injection in eyes with refractory neovascular glaucoma. Methods A retrospective chart review of patients with medically uncontrolled neovascular glaucoma who had received 50-µL intracameral bevacizumab (1.25 mg) before undergoing Ex-PRESS mini glaucoma shunt implantation was performed. Success was defined as a postoperative intraocular pressure (IOP) between 5 and 21 mm Hg without (complete success) or with or without (qualified success) glaucoma medications and no additional glaucoma surgery, or loss of light perception. Results In total, 33 eyes of 33 patients (15 female, 18 male) were enrolled in the study. The mean age of the study population was 61.2 years (range 36-78). The mean IOP decreased from 41.0 mm Hg (range 24-72) to 17.6 mm Hg (range 8-28) over a mean follow-up of 20.9 months (range 6-60) (pConclusions Ex-PRESS mini glaucoma shunt implantation with preoperative bevacizumab injection may be an effective alternative procedure for refractory neovascular glaucoma.

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 report the outcomes of corneal fine needle diathermy (FND) with adjuvant intrastromal and subconjunctival bevacizumab injection for corneal neovascularization (CN) in children.Methods:Medical records of all children who had undergone FND with adjuvant bevacizumab injection were reviewed r

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.

This retrospective case series assessed the influence of unilateral intravitreal bevacizumab (IVB) for unilateral type 1 retinopathy of prematurity (ROP) on macular thickness and foveal development. Seven infants with unilateral type 1 ROP were treated with intravitreal bevacizumab 0.625 mg/0.025 ml in one eye only. To determine whether macular thickness and fovea structural development were affected by treatment, spectral domain optical coherence tomography was performed on both treated and untreated eyes. The mean gestational age of infants was 25.3 ± 0.3 weeks; the mean birth weight, 776 ± 17.6 g. Treatment was given at a mean postmenstrual age of 37.2 ± 0.4 weeks. Foveal development was normal in 3 (43%) treated versus 5 (71%) untreated eyes. The mean central foveal thickness for treated and untreated eyes was 270.1 μm ± 19.6 and 253.0 μm ± 27.2 respectively (P = 0.15). There was small but nonsignificant difference in foveal development and thickness in eyes treated with intravitreal bevacizumab compared to fellow eyes. This study generates important data to test the hypothesis that foveal thickness is greater in unilateral type 1 ROP eyes treated with IVB compared to untreated fellow eyes.

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.

The aim of this study is to evaluate the efficacy and safety of subconjunctival bevacizumab injection(s) in the treatment of impending recurrent pterygia. Twenty-three eyes of 23 patients who developed impending recurrence after pterygium surgery with conjunctival autografting and were treated with subconjunctival bevacizumab injection(s) (2.5 mg/0.1 mL) were included in the study. Anterior segment photographs were taken prior to and at 1 week, 1, 3 and 6 months after the injection, and at the end of the follow-up period. Image analysis was performed using an image processing and analysis software program. Recurrence rate and complications were recorded. The mean age and follow-up time of the patients were 51.2 ± 6.2 (31–60 years) and 16.8 ± 3.1 (12–22 months), respectively. The average number of injections was 2 ± 0.78 (1–3). Sixteen eyes required re-injection (two injections in nine eyes, three injections in seven eyes), due to progression of vascularization. There were significant differences between size percentage of lesions before injection and at 1 week, 1, 3 and 6 months after the injection (p < 0.05 for all). Corneal recurrence developed in only one patient and no ocular or systemic side-effects of bevacizumab were observed. Repeated injections of bevacizumab may help to prevent the high recurrence rate of residual impending pterygium, due to its adjuvant role in decreasing lesion size, especially in the first year after surgery.

To evaluate the effects of various doses of subconjunctival bevacizumab injections in the treatment of patients with corneal neovascularization. During the 6-month-follow-up, no significant ocular or systemic adverse events were observed related to the subconjunctival bevacizumab injection. In Group 1, the total area of corneal neovascularization before injection was 14.8 ± 3.2 % of the corneal surface and 10.2 ± 2.8 % 6 months after injection (p0.01). The mean decrease in Group 1 was 32.0 ± 3.0 %. In Group 2, the total area of corneal neovascularization before and 6 months after the injection was 14.2 ± 2.5 and 9.8 ± 2.3 %, respectively (p0.01). The mean decrease in Group 2 was 31.0 ± 2.3 %. The difference between the two groups was not statistically significant (p0.05). Twenty-four eyes of 24 patients with corneal neovascularization who were treated with a subconjunctival injection of bevacizumab were included in this retrospective study. Fourteen eyes were treated with 2.5 mg/0.1 ml (Group 1), and 10 eyes were treated with 5.0 mg/0.2 ml (Group 2) of subconjunctival bevacizumab. Digital photographs of the cornea were used to determine the area of corneal neovascularization before injection and at 1 month, 3 months, and 6 months after treatment. Subconjunctival injection of bevacizumab is well tolerated and associated with a partial regression of corneal neovascularization. The efficacy of this treatment is not correlated to the injection dose.

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.

To evaluate the efficacy and safety of intralesional injection of bevacizumab on primary pterygium treatment.In this randomized controlled trial, each primary pterygium patient was randomized to receive either an intralesional injection of bevacizumab 2 mg (1 mg/0.04 mL) or a combination of topical antihistamine (antazoline HCl 0.05%) and vasoconstrictor (tetrahydrozoline HCl 0.04%) as a control. The main outcome measurements were symptoms and signs (including eye irritation, epiphora, redness, amount of discharge, inflammation and elevation of pterygium, and percentage of corneal pterygium area).A total of 74 pterygium eyes in 66 patients were randomized and allocated into a treatment group (N = 34) and a control group (N = 40). In the treatment group, there was a statistically significant reduction of symptoms (including irritation, photophobia, epiphora, redness, discharge, and blurred vision) and signs (inflammation and corneal pterygium area) compared with the baseline, up to at least 6 months. Between the treatment and control groups, no significant differences were found for all visits with respect to the (1) symptoms, (2) signs, and (3) percentage of corneal pterygium.Intralesional bevacizumab may have a therapeutic effect on symptoms and signs of primary pterygium for at least 6 months (ie, the follow-up period), with no serious ocular or systemic adverse effects.

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.

Purpose To report the effect of intrastromal injection of bevacizumab in an eye with extensive corneal stromal vascularization after deep anterior lamellar keratoplasty. Methods Bevacizumab (2.5 mg/1 mL) was injected into the deep corneal stroma of an eye with severe and extensive stromal vascularization. Results Corneal vascularization regressed dramatically after deep stromal injection of bevacizumab with no recurrence after 6 months. Visual acuity was improved, and the patient's complaints subsided. Conclusions Corneal intrastromal injection of bevacizumab can be considered for management of intrastromal vascularization after deep anterior lamellar keratoplasty.

BACKGROUND AND OBJECTIVE: To report the development of subretinal fibrosis after the injection of intravitreal bevacizumab in eyes with proliferative diabetic retinopathy (PDR) refractory to panretinal laser photocoagulation (PRP). PATIENTS AND METHODS: Twenty-one eyes of 15 patients treated with PRP and intravitreal injection of bevacizumab were included in this study. The clinical outcomes of 21 eyes having subretinal fibrosis after intravitreal bevacizumab injection were reviewed. RESULTS: There were 9 men and 6 women with a mean age of 51.3 ± 8.9 years. All eyes had PDR refractory to panretinal photocoagulation and were treated with at least one intravitreal injection of 1.25 mg of bevacizumab (mean number of injections: 1.8). Before injection, there was subretinal fibrosis in 5 eyes and vitreoretinal traction in 19 eyes. After a mean follow-up period of 7 months, the development or progression of subretinal fibrosis was detected in all eyes. CONCLUSION: Intravitreal injection of bevacizumab may cause formation or progression of subretinal fibrosis in patients with PDR refractory to PRP. [Ophthalmic Surg Lasers Imaging 2010;41:190–195.]

To evaluate the effect of intravitreal bevacizumab on visual acuity (VA) and central retinal thickness (CRT) in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).Retrospective review.The study included 42 patients with ME secondary to BRVO who received intravitreal injections of bevacizumab in 2 referral-based retinal practices in Vancouver, B.C., between November 2005 and July 2006.We performed a retrospective review of consecutive patients with ME secondary to BRVO. All of the patients in this study had nonischemic BRVOs. Patients were all treated with at least 1 bevacizumab injection and were seen at 6- to 8-week intervals for VA testing. Most of the patients also underwent optical coherence tomography (OCT) 2 months and 6 months after treatment. VA and OCT measurements at each follow-up time point were compared with the baseline values.A total of 42 eyes from 42 patients with ME secondary to BRVO were reviewed. The mean VA improved from 20/280 at baseline to 20/180 at first follow-up session (p0.04; average follow-up = 42 days) and remained at a similar level, 20/170, through the eighth follow-up session (p0.04; average follow-up = 356). The CRT was reduced from a mean of 451 microm (388-512 microm) at baseline to 358 microm (298-418 microm) at 2 months (p0.02) and to 400 microm (335-465 microm) at 6 months postinjection (p0.068).We found a significant improvement in VA and CRT in patients with ME secondary to BRVO after intravitreal bevacizumab injection(s). No complications or serious side effects were observed. Intravitreal bevacizumab appears to have an emerging role as either a primary or an adjuvant treatment modality in the setting of ME secondary to BRVO.

Bei einer 76-jahrigen Patientin mit extrafoveal okkulter choroidaler Neovaskularisation (CNV) bei altersbedingter Makuladegeneration (AMD) entwickelten sich 1 Tag nach der 7. Bevacizumab-Injektion Symptome ahnlich einer Endophthalmitis. Die Diagnose ergab eine Immunreaktion mit Pseudohypopyon nach mehrfachen Bevacizumab-Injektionen. Der Befund bildete sich innerhalb von 5 Tagen unter alleiniger Kortikosteroid-Behandlung komplett zuruck. Daraufhin erfolgte die Weiterbehandlung mit Pegaptanib, und es trat kein intraokularer Reizzustand mehr auf.

To report on the clinical use of subconjunctival bevacizumab in patients with corneal neovascularization.The charts of 10 consecutive patients with corneal neovascularization who received subconjunctival injections of bevacizumab (2.5 mg/0.1 mL) were reviewed. Digital photographs of the cornea were graded by 2 masked observers for density, extent, and centricity of corneal vascularization. Image analysis was used to determine the area of cornea covered by neovascularization as a percentage of the total corneal area.No significant ocular or systemic adverse events were observed during 3.5 +/- 1.1 months of follow-up. Seven patients showed partial regression of vessels. The extent decreased from 6.0 +/- 1.2 (SD) clock hours before the injection to 4.6 +/- 1.0 clock hours after bevacizumab injection (P = 0.008). Density decreased from 2.7 +/- 0.2 to 1.9 +/- 0.3, respectively. (P = 0.007). No change was noticed in the centricity of corneal vessels. Corneal neovascularization covered, on average, 14.8% +/- 2.5% (SD) of the corneal surface before the injections, compared with 10.5% +/- 2.8% (P = 0.36, t test) after bevacizumab injection. Therefore, bevacizumab decreased corneal neovascularization by 29%.Short-term results suggest that subconjunctival bevacizumab is well tolerated and associated with a partial regression of corneal neovascularization.

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.

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.

Purpose To describe a technique for treating pterygium by combining a subpterygial injection of bevacizumab followed by pterygial ligation. Methods Bevacizumab (1.25 mg/0.05 mL) was injected into the base of pterygia in 4 patients, and the pterygial necks were ligated. Results The heads of the pterygia regressed and disappeared within 7 days after treatment. The bodies also partially regressed and well-defined vessels were not seen on the bodies; however, the concentration of microvessels was higher on the pterygial bodies than in the normal conjunctiva after 1 month. A recurrence was defined as fibrovascular growth of conjunctival tissue that extended beyond the limbus. No complications or recurrences were noted during the follow-up period. Conclusions Although only 4 cases were studied, the uniform finding demonstrated that combined subpterygial bevacizumab injection and pterygial ligation is a potential effective procedure for removing pterygium.

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)

To study prognostic spectral domain optical coherence tomography parameters in diabetic cystoid macular edema after anti-vascular endothelial growth factor therapy.Retrospective cohort study included 49 eyes with the new onset diabetic cystoid macular edema that had to have a macular spectral domain optical coherence tomography and fluorescein angiography at presentation. The baseline optical coherence tomography scans were analyzed for variables indicative of the extent of retinal involvement by the cystoid change and its location about the center. Univariate and multivariate analyses were performed comparing the optical coherence tomography findings between the two groups of eyes: the "No improvement" and the "Improvement" groups, based on at least two Snellen lines improvement after treatment.There were 30 and 19 eyes in the No improvement and Improvement groups, respectively. In the univariate analysis, the baseline optical coherence tomography parameters associated with visual improvement included the photoreceptor inner segments thickness centrally (P = 0.009) and within the central 1-mm subfield (P0.0001), and the presence of bridging retinal processes centrally (P = 0.004). Multivariate analysis showed both presence and central location of bridging retinal processes within the central 1-mm subfield to be significantly associated with visual improvement (P = 0.041 and 0.005, respectively), with an odds ratio of 13.4 (95% confidence interval, 1.336-636.18; P = 0.010) for their central location.In diabetic cystoid macular edema, visual improvement after anti-vascular endothelial growth factor therapy is more likely to occur in eyes with residual central retinal processes on baseline macular spectral domain optical coherence tomography. This finding may be helpful in patient counseling, case selection, and clinical trial planning.

Purpose To report the effect of superficial keratectomy combined with subconjunctival bevacizumab injection in 2 cases of corneal neovascularization (NV). Methods An interventional case series was undertaken on 2 patients with corneal NV: 1 due to sclerokeratitis secondary to rheumatoid arthritis and the other due to Terrien marginal degeneration. Both patients underwent superficial keratectomy combined with subconjunctival bevacizumab injection (2.5 mg/0.1 mL). Results Corneal NV regressed with the surgical removal and showed no signs of recurrence after 3 months of follow-up. Both patients reported dramatic subjective improvement in their vision within 1-2 weeks. Best corrected visual acuity improved in 1 patient. Conclusion The combination of superficial keratectomy with subconjunctival injection of bevacizumab may offer a new strategy for the treatment of superficial corneal NV.

Purpose To report 7 cases of recurrent corneal neovascularization (NV) and lipid deposition after subconjunctival injection of bevacizumab for the treatment of corneal NV-induced lipid keratopathy. Methods We conducted a prospective interventional case series that included 20 eyes of chronic lipid keratopathy that received bevacizumab injection for the treatment of corneal NV and lipid deposition, including 7 eyes with recurrent corneal NV and lipid deposition after ceasing treatment. Repeated subconjunctival injections of bevacizumab were performed in 5 patients with recurrence. Penetrating keratoplasty was performed in 1 patient who had severely recurrent lipid deposition. Clinical presentation of corneal NV and lipid deposition, best-corrected visual acuity, and complications after treatments were recorded. Results Bevacizumab inhibited corneal NV and lipid depositions in 19 patients. Seven of the 20 patients (35%) had different patterns of recurrence of corneal NV/lipid deposition 6 to 15 months after discontinuing treatment. Five of the 7 patients in whom corneal NV/lipid deposition was recurrent received another course of repeated bevacizumab treatments. Three eyes had partial response to the second course of treatment. Two eyes had too short re-treatment course to have conclusions. One patient who received penetrating keratoplasty had successful result after surgery. Conclusions Corneal NV and lipid deposition may recur after ceasing the subconjunctival bevacizumab injections for lipid keratopathy. Some patients respond at least partially to repeated injections.

PURPOSE To assess the overall risk of needlestick injuries (NSIs) associated with intravitreal injection, and more specifically related to the practice of compounding pharmacies of applying informational adhesive stickers to repackaged bevacizumab injection syringes. METHODS This cross-sectional study involved an online survey of retina specialists in the United States. RESULTS Of the 717 invited retina specialists, 158 (22%) responded to the online survey. The respondents reported using 1 pair of gloves (51%), no gloves (46%), or 2 pairs of gloves (3%) during intravitreal injection. Repackaged bevacizumab syringes distributed by compounding pharmacy were used by 89% of the respondents, and 63% reported that the adhesive sticker was applied directly to the syringe. Unintentional adhesion between the sticker and hand or glove was experienced by 9% of respondents. At least 1 NSI during intravitreal injection was experienced by 8% of respondents, and sticker-related injury was reported by 3%. The sticker was perceived to increase risk for NSI by 33% of respondents. CONCLUSION This survey showed that 8% of the responding physicians surveyed have experienced at least one NSI during intravitreal injections, of which approximately one third was attributed to the adhesive sticker. Direct application of misfitting stickers to repackaged syringes by compounding pharmacies may be a practice that can aggravate the risk of NSI.

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.

We describe a case of recipient bed melt and wound dehiscence after uneventful penetrating keratoplasty and subconjunctival injection of bevacizumab. Three weeks postoperatively, the patient presented with limbal ischemia, recipient bed melt, and wound dehiscence corresponding to the area of bevacizumab injection. The melt was managed by application of cyanoacrylate glue along with bandage contact lens. Although the graft survived, there was a problem in re-epithelization. This case highlights the need for further studies to elucidate the therapeutic dose, side effects, and correct timing of using bevacizumab with respect to corneal transplant surgery.