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Objective: To evaluate the effect of conjunctival vitreous reflux on intraocular pressure immediately after intravitreal bevacizumab injection. Methods: A prospective interventional study was done at Benazir Bhutto Hospital, for 6 months from 13-01-2021 to 12-07-2021.Patients were selected through a non-probability consecutive sampling technique. A total of 88 eyes undergoing intravitreal bevacizumab were included in the study. IOP was checked before injection, immediately after injection, at 30 minutes and 60 minutes. The presence or absence of conjunctival reflux was noted. Data was analyzed to see the association of post-injection IOP and conjunctival reflux. Results: Those having conjunctival reflux positive had mean Intraocular pressure before intravitreal injection 13.14+2.569, the p-value was 0.0001. Immediately after injection at 0 minutes it was 27.95+3.988, and the p value was 0.0001. At 30 minutes, it was reduced to 21.58+2.814, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 17.26+1.853, and the p-value was 0.001. Those having conjunctival reflux negative had mean Intraocular pressure before intravitreal injection 13.44+2.981, p-value 0.0001. Immediately after injection at 0 minutes it was 33.69+5.608, and the p-value was 0.0001. At 30 minutes, it was reduced to 24.51+5.337, the p-value was 0.0001, and at 60 minutes, the mean intraocular pressure was 18.98+2.973, and the p-value was 0.001. Conclusion: Patients with vitreous reflux positive had less IOP elevation as compared to those with vitreous reflux negative. [ABSTRACT FROM AUTHOR]

Purpose: To report the incidence, management, and clinical outcomes of cases who developed acute endophthalmitis following the administering of the intravitreal bevacizumab (IVB) injection. Methods: In this retrospective, non-comparative, single-center, cross-sectional study, the records of patients diagnosed with acute endophthalmitis following IVB injection between March 2013 and October 2019 were reviewed. Immediate injection of intravitreal antibiotics and early pars plana vitrectomy was performed for all cases after clinical diagnosis of acute post IVB endophthalmitis. Results: A total of 28,085 IVB injections were performed during the study period. Nine eyes of nine patients developed acute post IVB endophthalmitis giving an overall incidence of 0.032% (95% CI, 0.01–0.06) (3.2 in 10,000 injections). Three cases (33%) were culture-positive (staphylococcus epidermidis). The mean time between IVB injection and presentation of endophthalmithis was 2.77 ± 1.25 days (Range, 1–6). The mean number of previously received IVB injections before developing of endophthalmitis was 4 ± 1.5 (range 2 to7). The mean best corrected visual acuity (BCVA) before IVB injection, at the presentation of endophthalmithis and three months after the treatment of endophthalmithis were 1.18 ± 0.62, 2.5 ± 0.42, and 1.94 ± 0.88 logMAR, respectively (P = 0.025). One eye developed phthisis bulbi. Conclusion: The incidence of acute endophthalmitis following Intravitreal injection of bevacizumab is very low. The time interval between injection and presentation is short. Prompt treatment with immediate intravitreal antibiotics and early pars plana vitrectomy are key in maximizing outcomes. The prognosis of post-IVB endophthalmitis is poor and may result in significantly visual impairment. [ABSTRACT FROM AUTHOR]

Atsuko Sato, Emi Fukui, Kouichi Ohta Department of Ophthalmology, Matsumoto Dental University, Shiojiri, Nagano, JapanCorrespondence: Atsuko SatoDepartment of Ophthalmology, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, JapanTel/Fax +81-263-51-2210Email atsuko.sato@mdu.ac.jpPurpose: To report a case of a full-thickness macular hole (MH) that developed after cryotherapy and intravitreal bevacizumab injection (IVB) to treat a retinal vasoproliferative tumor (VPT).Methods: Case report of a man with a retinal VPT.Results: A 64-year-old Japanese man complained of blurred vision in his right eye. At the initial examination, his best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/20 in the left eye. Ophthalmoscopy showed a VPT in the lower peripheral retina of the right eye. An exudative retinal detachment and hard exudates were seen around the tumor. Cryotherapy and intravitreal injections of bevacizumab (IVB) were performed. Although the exudative changes were reduced, a MH developed two months after the initial IVB treatment. He underwent 25-gauge pars plana vitrectomy, and the MH was closed. His postoperative BCVA was 20/32 and the VPT was inactive. The reduced BCVA was due to damage of the outer retinal layers.Conclusion: Our findings indicate that cryotherapy and IVB are effective treatments for VPT although the possibility of developing a MH should be considered.Keywords: intravitreal bevacizumab injection, macular hole, optical coherence tomography, vasoproliferative tumor, vitrectomy

Supplemental Digital Content is Available in the Text. Severe fibrovascular proliferation can develop in eyes with aggressive posterior retinopathy of prematurity despite treatment with intravitreal bevacizumab and laser photocoagulation. Purpose: To describe the clinical features of severe recurrent fibrovascular proliferation after intravitreal bevacizumab injections and laser photocoagulation for aggressive posterior retinopathy of prematurity. Methods: This retrospective, nonrandomized case series reviewed the medical and ophthalmic records in the referral hospital and our hospital. Patients: Four patients (seven eyes) with aggressive posterior retinopathy of prematurity. Results: The patients were referred for vitrectomy with/without lensectomy for recurrent fibrovascular proliferation with a tractional retinal detachment after combined intravitreal bevacizumab injections and laser photocoagulation. Three patients were born at 22 weeks or 23 weeks' gestational age and one patient at 29 weeks' gestational age. Preoperatively, fluorescein angiography images showed all eyes had tractional retinal detachment from regrowth of fibrovascular proliferation 3 months to 5 months after the intravitreal bevacizumab injection and abnormal retinal vasculature; four eyes had a broad ischemic retina. Postoperatively, four eyes had retinal attachment and three eyes a total retinal detachment. Neovascular glaucoma developed in five of the seven eyes during the clinical course. Conclusion: Severe fibrovascular proliferation may recur due to widespread retinal ischemia with capillary dropout and abnormal vasculature after failed combined intravitreal bevacizumab and laser photocoagulation therapy as the initial treatment for aggressive posterior retinopathy of prematurity. Careful follow-up is important especially after anti–vascular endothelial growth factor treatment, with recognition that severe reactivation is possible. [ABSTRACT FROM AUTHOR]

Kinya Tsubota, Yoshihiko Usui, Yoshihiro Wakabayashi, Jun Suzuki, Shunichiro Ueda, Hiroshi GotoDepartment of Ophthalmology, Tokyo Medical University Hospital, Tokyo, JapanPurpose: This study aimed to elucidate the effects of intravitreal bevacizumab (IVB) injections for the prevention of post-vitrectomy complications in proliferative diabetic retinopathy (PDR) patients with elevated vitreous vascular endothelial growth factor (VEGF) concentration. Design: Prospective case series. Methods: Thirty-three patients (42 eyes) with PDR who underwent primary vitrectomy in the Department of Ophthalmology, Tokyo Medical University Hospital were studied. We measured VEGF concentrations in vitreous humor collected at the time of vitrectomy using ELISA. IVB injections were performed after vitrectomy in patients with vitreous VEGF levels exceeding 1,000 pg/mL. New bleeding occurring within 1 month of vitrectomy was defined as early vitreous hemorrhage (VH). Main outcome measure: The incidence of complications after vitrectomy including postoperative early VH. Results: IVB injections were administered to 11 eyes (26%) with vitreous VEGF concentrations exceeding 1,000 pg/mL. None of the 11 eyes that received an IVB injection developed early VH. Among 31 eyes (74%) with vitreous VEGF concentrations lower than 1,000 pg/mL, two eyes (6%) developed early VH after vitrectomy. Conclusions: Prophylactic IVB injections administered to patients with elevated preoperative intraocular VEGF concentrations were effective in preventing post-vitrectomy early VH.Keywords: diabetic retinopathy, VEGF, vitreous hemorrhage, intravitreal bevacizumab injection

Objective: To evaluate the changes in aqueous concentrations of inflammatory cytokines and fibrosis-related factors, and to detect the expression of vascular endothelial growth factor (VEGF) and proliferating cells in fibrovascular membranes (FVMs) of patients with proliferative diabetic retinopathy (PDR) after injection of intravitreal bevacizumab (IVB). Methods: Forty-two eyes of 42 patients with PDR, including 28 eyes that received IVB (1.25 mg) 2, 5, and 14 days before pars plana vitrectomy (PPV), and 14 eyes without IVB, were enrolled, in addition to 10 eyes of 10 patients with nondiabetic ocular diseases. Aqueous concentrations of inflammatory cytokines and fibrosis-related factors were analyzed by a multiplex bead assay. Fluorescence immunostaining was performed to examine the expression of VEGF and proliferating cells in the excised epiretinal membranes. Results: PDR eyes without IVB had the highest vitreous VEGF levels, and the level was statistically significant compared with that of PDR eyes that received IVB 2 days before surgery, PDR eyes that received IVB 5 days before surgery, and nondiabetic eyes (p = 0.011, p = 0.012, and p < 0.001, respectively). The expression of fibroblastic cells and connective tissue growth factor increased in epiretinal FVMs of the IVB group 21 days after treatment. Conclusions: IVB injection may lead to a decrease in the intraocular concentrations of VEGF after 2–5 days and induce the formation of proliferation after 21 days, which suggests that PPV in PDR patients should take place within 1 week of the administration of preoperative IVB. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema. Materials and Methods: This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen′s visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis. Results: In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group. Conclusion: Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.

AIM: To observe the clinical curative effect of intravitreal Bevacizumab injection combined duplex technique in treatment of neovascular glaucoma(NVG).METHODS:Totally 25 eyes of 25 patients with NVG who underwent intravitreal Bevacizumab injection of 1.0mg(0.05mL), after the regression of iris neovascularization, 5 eyes with anterior chamber paracentesis fluid auxiliary controlled intraocular pressure. After 2wk, patients were treated by trabeculectomy and phacomulsification(9 eyes were implanted intraocular lens). The changes and complications of intraocular pressure, visual acuity, corneas and neovessels were observed after surgery, and followed up 12mo.RESULTS:After injection Bevacizumab in 25 eyes, iris neovascularization of 20 eyes subsided in 3～5d, and 5 eyes subsided in 7d. After controlling intraocular pressure, count of the corneal endothelial cell were 1 629±226mm2, and none suffered decompensation of corneal endothelium after two-surgery of trabeculectomy and phacomulsification. After followed up 12mo, intraocular pressure of 20 eyes were controlled in normal range; 2 eyes could control in normal range after treated by a kind of anti-glaucoma medicine and 3 eyes was 34～38mmHg after treated by anti-glaucoma medicine. 9 eyes had improved vision after implanted intraocular lens.CONCLUSION:Intravitreal Bevacizumab injection can subside iris and anterior chamber angle neovascularization effectively in a short time and reduce intraocular pressure. It can also reduce the risk of bleeding during operation or after operation. Intravitreal Bevacizumab injection combined with two-surgery of trabeculectomy and phacomulsification can treat neovascular glaucoma effectively.

Introduction: The clinical use of intravitreal bevacizumab (IVB), a recombinant humanized monoclonal antibody that functions as an anti-vascular endothelial growth factor (anti-VEGF), has recently increased in patients with retinal ischemic diseases such as proliferative diabetic retinopathy (PDR). The short-term and long-term complications associated with this procedure have not been well established. We aimed to study the possible short-term complication of intraocular pressure (IOP) fluctuations shortly after IVB injection in patients with PDR., Materials and Methods: A prospective case series of diabetic patients with PDR who underwent IVB injection was performed in the Department of Ophthalmology, Medical Teaching Institution, Khyber Teaching Hospital, Peshawar, Pakistan, from November 1, 2020, to May 1, 2021. The total number of PDR patients of both sexes included in the study was 101. A slit lamp examination was performed, and IOP readings were recorded before and 30 min after IVB injection using Goldmann applanation tonometry (GAT). IBM Statistical Package for the Social Sciences version 22 for Windows was used to analyze the data. Safety of the procedure, defined as IOP ≤ 20 mmHg 30 min after IVB injection, was determined and stratified according to sex, age, duration of diabetes, and baseline IOP. A post-stratification chi-square test was applied, and a p-value <0.05 was taken as statistically significant., Results: In this study, 60.4% of the participants were male and 39.6% were female. The age of the patients ranged from 30 to 75 years, with a mean age of 55.66±6.37 years. The mean duration of diabetes among the participants was 7.73±2.94 years and the mean baseline IOP was 15.40±1.77 mmHg. Safety (IOP ≤ 20 mmHg 30 min after IVB injection) was observed in 90.1% of the patients., Conclusion: IVB injections are safe for use in patients with PDR in terms of immediate IOP changes. However, patients with higher baseline IOP (>15 mmHg) are more likely to develop increased IOP post-procedure and prophylaxis may be prudent in such cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Luqman et al.)

Purpose: To evaluate the effect of a single intravitreal bevacizumab (IVB) injection on blood flow parameters in the ophthalmic artery (OA) and middle cerebral artery (MCA) in infants with retinopathy of prematurity (ROP). Materials and Methods: This prospective and interventional study included 15 infants with ROP who were treated with IVB. Peak systolic velocity (PSV), end-diastolic velocity, mean velocity (MV) and resistivity index were measured using pulse wave Doppler ultrasonography (Philips En Visor C, Amsterdam, The Netherlands) in the OA and MCA, before IVB injection and 1 day, 1 week and 1 month after IVB injection. Results: Measurements of PSV-OA, MV-OA and PSV-MCA showed significant changes after IVB treatment (p = 0.01, p = 0.02, p = 0.02, respectively). The PSV-OA measurements at 1 week and 1 month were significantly lower than the baseline PSVReceived OA measurement (p = 0.03 and p = 0.01, respectively). The MV-OA measurement was significantly lower at 1 month following IVB as compared to the baseline MV-OA measurement (p = 0.03). The PSV-MCA showed a significant decline 1 day after IVB injection (p = 0.03). Conclusions: The study demonstrated that IVB causes significant alterations in blood flow parameters in the OA and MCA predicted by Doppler ultrasonography in infants with ROP. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema. Materials and Methods: This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen's visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis. Results: In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group. Conclusion: Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of central vision loss in a patient with choroideremia. Patients and methods: A retrospective, interventional case report. Results: A 13-year-old male with history of choroideremia presented with subacute loss of central acuity in his left eye. Examination and diagnostic testing revealed subretinal fibrosis secondary to a choroidal neovascular membrane (CNVM). A trial of anti-vascular endothelial growth factor (VEGF) therapy with the injection of intravitreal bevacizumab was attempted. Mild improvements in acuity and anatomy were noted. Conclusion: Choroideremia is a rare hereditary choroidal dystrophy that predominantly affects males in the first and second decades of life. Visual acuity is usually spared until later in life. CNVM is a rare manifestation of choroideremia with only a handful of case reports presented in the literature. This case is unique in that it is the first reported case that received treatment with intravitreal anti-VEGF therapy. [ABSTRACT FROM AUTHOR]

Abstract: Background/Purpose: To evaluate the effect of intravitreal bevacizumab on subretinal fluid absorption in patients with chronic central serous chorioretinopathy (CSCR). Materials and methods: This was a retrospective case series study. Patients with CSCR symptoms for > 3 months and who received intravitreal injection of bevacizumab were included. Ocular examinations were carried out at baseline and every follow-up visit, including visual acuity, fundus examination, and optic coherence tomography. Results: Twelve eyes in 12 patients were included in this study. One month after injection, three of the 12 patients who had increased central macular thickness were considered nonresponders. Nine of the 12 patients who had decreased central macular thickness were considered to have responded to intravitreal bevacizumab injection. The response rate was 75%. In the response group, the mean central macular thickness significantly decreased, from 306.7 ± 77.8 μm to 204.3 ± 59.3 μm (p = 0.001) at 1 month. The mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity was significantly improved from 0.72 ± 0.35 to 0.50 ± 0.28 (p = 0.008). Six of these nine patients had stable conditions lasting > 6 months. Three of them had recurrence. Conclusion: Intravitreal bevacizumab injections improved subretinal fluid absorption in some patients with CSCR. It could be an alternative therapy for patients with CSCR, especially when they are not suitable for other treatments. [Copyright &y& Elsevier]

Background: To evaluate the efficacy of intravitreal bevacizumab injection in the treatment of central serous chorioretinopathy (CSC). Methods: In a prospective interventional case series, 40 eyes of 40 patients with idiopathic CSC at least 3 months in duration were included. Patients were treated with once or twice intravitreal bevacizumab injections initially and completed at least 12 months follow-up. Main outcomes measures were the resolution of neurosensory detachment, best-corrected visual acuity, and findings on fluorescein and indocyanine green angiography. Results: Thirty-three of 40 eyes (82.5%) showed complete absence of subretinal fluid at the macula within 3 months following initial intravitreal bevacizumab injection. Eyes exhibiting resolution of subretinal fluid revealed improvement in fluorescein and indocyanine green angiographic findings. The rate of intense hyperfluorescence on indocyanine green angiography was higher in eyes exhibiting resolution of subretinal fluid than eyes exhibiting incomplete absorption of subretinal fluid after intravitreal bevacizumab (72.7 and 28.5%, respectively, p = 0.039). Conclusions: Intravitreal bevacizumab injections generally resulted in anatomic improvement for CSC and may constitute a therapeutic option in CSC. The effect after intravitreal bevacizumab injection for CSC might be related to the hyperfluorescence on indocyanine green angiography. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate outcomes of intravitreal injection of bevacizumab for the treatment of severe retinopathy of prematurity (ROP) associated with vitreous or retinal hemorrhages (VH or RH). Methods: This is a prospective interventional case-series. Fourteen eyes of eight premature infants with severe ROP associated with vitreous or retinal hemorrhage were consecutively included. In eight eyes, VH and/or RH precluding complete laser ablation developed at the time of laser treatment. In six eyes, VH developed early after laser ablation. All participants underwent intravitreal injection of 0.625 mg (0.025 ml) bevacizumab immediately after diagnosis of VH or RH. Follow-up examinations were performed at days 1, 3, 7, and 14, and 1, 2 and 3 months after injection. Main outcome measure was the absence of unfavorable structural outcomes. Results: Mean gestational age was 27.6 weeks (range, 26-29 weeks) and mean birth weight was 1047 g (range, 780-1500 g). Mean gestational age at the time of injection was 35.4 weeks (range, 32-38 weeks). In all eyes, plus disease disappeared completely within 2 weeks and VH and/or RH was absorbed at last follow-up. None of the eyes developed unfavorable structural outcomes. No eyes needed additional injection or laser treatment. No major systemic or ocular complications were observed. Conclusion: In this small series of patients, intravitreal injection of bevacizumab was effective for treatment of severe retinopathy of prematurity associated with vitreous or retinal hemorrhage. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively study the efficacy of intravitreal bevacizumab (IVB) for exudative age-related macular degeneration (AMD) in patients with good visual acuity (VA). Methods: Fifteen eyes of 15 patients (mean age, 69.0 ± 11.3 years) with AMD whose VA was 0.6 or better were treated with IVB 1.25 mg/0.05 ml. The patients were followed for 12 to 29 months (mean, 17.4 ± 4.9 months). Results: Best-corrected visual acuity (BCVA) ranged from 0.6 to 1.2 (mean, 0.89 ± 0.21) at baseline and was stable in 13 of 15 eyes (86.7%) when BCVA was 0.6 or better at the end of follow-up. The VA levels did not differ significantly ( P = 0.42; paired t test) between baseline and the final examination. Two of the 15 eyes underwent photodynamic therapy during follow-up. The mean central retinal thickness significantly decreased from 278.4 ± 71.9 μm at baseline to 240.00 ± 58.5 μm at 3 months after the first IVB treatment ( P = 0.02; Wilcoxon signed rank test). During follow-up, a mean of two injections was administered, and 47% of patients required only one injection. No adverse events developed. Conclusion: IVB was effective for maintaining good vision in exudative AMD in 15 eyes for at least 12 months. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of persistent placoid maculopathy (PPM) associated with juxtafoveal choroidal neovascularization (CNV) treated with intravitreal bevacizumab injection (IVBI). Design: Interventional case report. Methods: A 60-year-old patient referred for sudden vision loss was diagnosed with PPM complicated by a disciform scar in the right eye and juxtafoveal CNV in the left eye, undergoing 2 IVBIs. Results: Best-corrected visual acuity passed from 20/32 to 20/20 after 2 IVBIs, with complete resolution of intraretinal and subretinal fluid and disappearance of fluorescein leakage. Conclusions: IVBI is a promising treatment option for juxtafoveal CNV secondary to PPM. [ABSTRACT FROM AUTHOR]

Introduction: The occurrence of a subretinal hematoma in age-related macular degeneration (AMD) is a serious complication that can impact the visual prognosis with a poor functional recovery. The management of this complication remains controversial. Several therapeutic methods have been described. We report the results of four patients treated with a protocol combining: vitrectomy, subretinal injection of r-TPA 0.025mg/0.3ml, intravitreal injection of 0.05ml of bevacizumab and retinal tamponade with 20% SF6 gas., Patients and Methods: Our series consists of four patients with a submacular hematoma complicating AMD, included in succession between October 2013 and October 2014 and treated with the same treatment protocol and by the same surgeon. All patients underwent surgery within eight days after the onset of the macular hematoma. Patients with a consultation period longer than eight days did not undergo this treatment. Face down postoperative positioning was then carried out for seven days by the patients., Results: We observed a shift in the macular hematoma in the four patients, which allowed the identification of secondary neovascularization responsible for the bleeding. The visual acuity improved in three patients from hand motion (HM) preoperatively to 2/10 at one month postoperatively. One patient maintained visual acuity 1/20 during the entire follow-up despite almost complete resorption of the subretinal hematoma. These visual acuities were stable at 6 months postoperatively., Discussion: Macular subretinal hematoma can cause severe visual loss by several mechanisms. The blood accumulates between the neurosensory retina and the retinal pigment epithelium, which causes a toxic effect on the surrounding tissues, thus resulting in a loss of photoreceptors and cellular destruction in the pigment epithelium and choriocapillaris, evolving into a fibroglial scar., Conclusion: The therapeutic evaluation of this protocol in our series of four patients gives a favorable result. We observed an improvement in visual acuity in 3/4 of cases. This surgical technique appears to be effective in the treatment of this complication of AMD. However, a study on a larger scale is needed to confirm these results., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Purpose: To present the functional and anatomic changes after intravitreal bevacizumab in eyes with macular edema (ME) due to branch retinal vein occlusion (BRVO)., Design: The study was a retrospective study., Materials and Methods: The study included 31 patients with ME due to BRVO. We compared the examination findings of patients with ME before and after intravitreal bevacizumab therapy at 12 months. The study included patients who had macular edema secondary to BRVO treated with bevacizumab. The therapy was started in the first week after occlusion. The initial therapy was three intravitreal bevacizumab injections at monthly intervals with 1.25/0.05 mL bevacizumab. Patients with a baseline visual acuity less than 0.5 (logarithm of the minimum angle of resolution [logMAR] 0.30), central macular thickness (CMT) more than 290 μm, and no neovascularization were included. Patients with diabetes mellitus or a history of intravitreal triamcinolone or grid laser photocoagulation therapy or ischemic BRVO were excluded. The retreatment criteria were as follows: increased CMT more than 100 μm combined with a loss of visual acuity of five or more letters. The statistical analysis of this study was carried out by paired samples t-test (SPSS). A P value of less than 0.05 was considered to be statistically significant., Results: This retrospective study included 33 eyes of 31 patients (20 women, 11 men; mean age was 55.30 ± 9.62 years (range 36-75 years). Patients received a mean of 5.3 injections during 12 months of follow-up. The best corrected visual acuity increased from 0.66 ± 0.20 (logMAR) at baseline to 0.22 ± 0.13 (logMAR) (t = 15.42; P < 0.001) at month 12. The CMT decreased from 494.15 ± 104.16 μm at baseline to 261.79 ± 45.36 μm at month 12 (- 232.36 ± 109.98 μm); P < 0.001). No bevacizumab-related systemic or ocular adverse effects following intravitreal drug injections were observed. The majority of patients required reinjection(s) treatment for ME (84.9%)., Conclusion: Intravitreal therapy using bevacizumab appears to be an effective primary treatment option for ME due to BRVO. No serious ophthalmologic or systemic side effects were observed for intravitreal bevacizumab therapy. The main disadvantage of bevacizumab therapy is the requirement of multiple injections in order to maintain visual and anatomic improvements.