Intravitreal Bevacizumab (Avastin) for Diabetic Retinopathy: The 2010 GLADAOF Lecture

This paper demonstrates multiple benefits of intravitreal bevacizumab (IVB) on diabetic retinopathy (DR) including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) at 24 months of followup. This is a retrospective multicenter interventional comparative case series of intravitreal injections of 1.25 or 2.5 mg of bevacizumab for DME, PDR without tractional retinal detachment (TRD), and patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 or 2.5 mg of bevacizumab before vitrectomy for the management of PDR. The results indicate that IVB injections may have a beneficial effect on macular thickness and visual acuity (VA) in diffuse DME. Therefore, in the future this new therapy could complement focal/grid laser photocoagulation in DME. In PDR, this new option could be an adjuvant agent to panretina photocoagulation so that more selective therapy may be applied. Finally, TRD in PDR may occur or progress after IVB used as an adjuvant to vitrectomy. Surgery should be performed 4 days after IVB. Most patients had poorly controlled diabetes mellitus associated with elevated HbA1c, insulin administration, PDR refractory to panretinal photocoagulation, and longer time between IVB and vitrectomy

Vitrectomy with complete posterior hyaloid removal for ischemic central retinal vein occlusion: Series of cases

BACKGROUND: Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated. CASE PRESENTATION: This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 ± 3.05 mmHg to 14.9 ± 2.69 mmHg post-operative and macular edema from 976 ± 196 μm to 640 ± 191 μm to six month. The P1 wave amplitude changed from 25.46 ± 12.4 mV to 20.54 ± 11.2 mV. CONCLUSION: A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers

Ultra widefield imaging of the retina [Imagen de retina de campo ultra-amplio]

Purpose To review the evolution and usefulness of ultra widefield images of the retina. Method Literature review. Results The ability to obtain images of the ocular fundus is one of the greatest breakthroughs in our specialty. This ability has refined over time, from obtaining images with a field of 30 degrees, to obtaining images that exceed 150 degrees using equipment such as the Optos Daytona (Optos, Dunfermline, United Kingdom) or the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany). These images are extremely useful to evaluate diseases such as diabetic retinopathy, retinal vascular occlusions, pediatric retinal pathology, posterior uveitis, and even diseases which classically affect the macula such as age-related macular degeneration. Conclusion Ultra widefield images of the retina have revolutionized the way we study and understand retinal pathology. As technology for obtaining these images becomes more accessible, it will surely become part of the routine evaluation of retinal diseases. © 2016 Sociedad Mexicana de Oftalmologí

PRIMARY INTRAVITREAL BEVACIZUMAB for SUBFOVEAL CHOROIDAL NEOVASCULARIZATION in AGE-RELATED MACULAR DEGENERATION Results of the Pan-American Collaborative Retina Study Group at 12 Months Follow-up

Purpose: To report the 12-month anatomic and Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin(TM), Genentech Inc., San Francisco, CA) (1.25 mg or 2.5 mg) in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration.Methods: Sixty-three eyes of 63 consecutive patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration, a mean age of 73.7 +/- 7.5 years and a minimum of 12 months (mean 55.5 +/- 6.2 weeks) of follow-up participated in this interventional retrospective multicenter case series in 7 centers from 6 countries. Patients were treated with at least 1 intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab. Patients underwent Early Treatment Diabetic Retinopathy Study BCVA testing, ophthalmoscopic examination, optical coherence tomography, and fluorescein angiography at baseline and follow-up visits. Repeated measures analysis of variance was used to compare mean values.Results: the mean number of intravitreal bevacizumab injections per eye was 3.5 (range, 1-8). Mean baseline BCVA was 20/320, logarithm of the minimum angle of resolution = 1.2, and mean final BCVA was 20/200, logarithm of the minimum angle of resolution = 1.0 (P < 0.001). Central macular thickness at baseline by optical coherence tomography had a mean of 389.2 +/- 149.6 mu m which was significantly reduced to a mean of 281.0 +/- 96.1 mu m, 268.2 +/- 82.6 mu m, 262.6 +/- 92.3 mu m, and 241.3 +/- 76.7 mu m at 1, 3, 6, and 12 months after initial treatment, respectively (P < 0.0001). Ocular adverse events included transient increased intraocular pressure in 2 (3.1%) eyes, endophthalmitis in 2 (3.1%) eyes, and transient hypotony in 1 eye (1.1%). No systemic adverse events were observed.Conclusion: Primary intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg seems to provide stability or improvement in BCVA, optical coherence tomography, and fluorescein angiography in subfoveal choroidal neovascularization secondary to age-related macular degeneration at 12 months.Clin Oftalmol Ctr Caracas, Retina & Vitreous Serv, Caracas 1010, VenezuelaHosp Dr Luis Sanchez Bulnes, Asociac Para Evitar Ceguera Mexico, Mexico City, DF, MexicoUniversidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, BrazilUniv Puerto Rico, San Juan, PR 00936 USAInst Cirugia Ocular, San Jose, Costa RicaHosp Univ Austral, Buenos Aires, DF, ArgentinaHosp Olhos Araraquara, Araraquara, SP, BrazilUniversidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, BrazilWeb of Scienc

Long-term follow-up of patients with choroidal neovascularization due to angioid streaks

Maria Guadalupe Martinez-Serrano,1 Abelardo Rodriguez-Reyes,2 Jose Luis Guerrero-Naranjo,1,3 Guillermo Salcedo-Villanueva,1 Jans Fromow-Guerra,1,3 Gerardo Garc&iacute;a-Aguirre,1,3 Virgilio Morales-Canton,1 Raul Velez-Montoya1,3 1Retina Department, 2Pathology Department, Asociaci&oacute;n para Evitar la Ceguera en Mexico, Hospital &ldquo;Dr Luis Sanchez Bulnes&rdquo; IAP, 3Macula Retina Consultants, Mexico City, Mexico Background: The following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV), secondary to angioid streaks (AS), who were treated with antiangiogenic drugs in a pro re nata (PRN) regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of aware&shy;ness and self-referral by the patients are believed to be the cause of the PRN regimen failure. Purpose: To assess the long-term outcomes (&gt;4 years) of patients with CNV due to AS treated with a PRN regimen of antiangiogenic. Methods: This was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA) over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of&nbsp;&le;0.05 for statistical significance. Results: The mean follow-up time was 53.8&plusmn;26.8 months. BCVA at baseline was: 1.001&plusmn;0.62 logMAR; at the end of follow-up: 0.996&plusmn;0.56 logMAR (P=0.9). Central macular thickness at baseline was: 360.85&plusmn;173.82 &micro;m; at the end of follow-up: 323.85&plusmn;100.34 &micro;m (P=0.6). Mean number of intravitreal angiogenic drugs: 6&plusmn;4.16 injections (range 4&ndash;15). Mean time between injections was 3.8&plusmn;2.7 months (range 1.9&ndash;5.8 months). Conclusion: Despite initial anatomical and functional improvement, patients at the end of the follow-up had no visual improvement after a pro re nata regimen of antiangiogenic drugs. The amount of retreatments, number of recurrences, and time between intravitreal injections were similar to previous reports with shorter follow-up. Keywords: angioid streaks, choroidal neovascularization, long term, antiangiogenic, bevacizumab, ranibizumab, outcom

Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with chronic central serous chorioretinopathy: Results of the Pan-American Collaborative Retina Study (PACORES) Group

"Purpose To compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT). Methods This is a multicentre, retrospective comparative study of 92 eyes treated with yellow MP laser (duty cycle of 5%, zero spacing between spots, spot size varied from 100 to 200 ?m, power varied from 320 to 660 mW, and the pulse burst duration was 200 ms) and 67 eyes treated with PDT (half-dose verteporfin (3 mg/m 2) infused over 10 min), followed by laser activation for 83 s. Spot sizes varied from 400 to 2000 ?m. Results In the MP group, at 12 months of follow-up, the mean best corrected visual acuity (BCVA) improved from the logarithm of the minimum angle of resolution (logMAR) of 0.41±0.27 at baseline to 0.21±0.26 (P less than 0.0001), 48.9% (45/92) of eyes had an improvement of ?3 lines of BCVA from baseline, 48.9% (45/92) of eyes remained within 2 lines of baseline BCVA, and only 2.2% (2/92) of eyes lost ?3 lines of BCVA from baseline. In the PDT group, at 12 months of follow-up, the mean BCVA changed from logMAR of 0.50±0.34 at baseline to 0.47±0.34 (P=0.89), 19% (13/67) of eyes had an improvement of ?3 lines of BCVA from baseline, 73% (49/67) of eyes remained within 2 lines of baseline BCVA, and 7% (5/67) of eyes lost ?3 lines of BCVA from baseline. There were no adverse events attributable to the yellow MP laser treatment. One eye in the PDT group developed choroidal neovascularisation, which was treated with three intravitreal bevacizumab injections. Conclusions Both PDT and MP are effective in restoring the macular anatomy. In places where PDT is not available, yellow MP laser may be an adequate treatment alternative. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema: Results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up

Background: To report the 12-month anatomic and ETDRS best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin®) (1.25 mg or 2.5 mg) in patients with diffuse diabetic macular edema (DDME). In addition, a comparison of the two different doses of intravitreal bevacizumab (IVB) utilized was made. Methods: We reviewed the clinical records of 82 consecutive patients (101 eyes) with DDME in this interventional retrospective multicenter study. All patients with a minimum follow-up of 12 months (mean 57.6±8.4 weeks) were included in this analysis. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Results: The mean age of our patients was 59.7±9.3 years. The mean number of IVB injections per eye was three (range: one to six injections) at a mean interval of 14.1±10.5 weeks. In the 1.25 mg group at 1 month BCVA improved from 20/190, logMAR=0.97 to 20/85, logMAR 0.62, a difference that was statistically significant (p=0.0001). This improvement was maintained throughout the 3-, 6-, and 12-month follow-up. The mean final BCVA at 12 months was 20/76, logMAR=0.58 (p less than 0.001), a statistically significant difference from baseline BCVA. Similar BCVA changes were observed in the 2.5 mg group. In the 1.25 mg group, the mean central macular thickness (CMT) decreased from 419.1±201.1 ?m at baseline to 295.11±91.5 ?m at 1 month, 302.1±124.2 m at 5 months, 313.4.1±96.3 m at 6 months, and 268.2±95.5 m at 12 months (plt;0.0001). Similar CMT changes were observed in the 2.5 mg group. Adverse events included transient high blood pressure in one patient (1.2%), transient increased intraocular pressure in one eye (1%), and tractional retinal detachment in one eye (1%). Conclusions: Primary IVB at doses of 1.25 to 2.5 mg seem to provide stability or improvement in BCVA, OCT, and FA in DDME at 12 months. There seems to be no difference in our results between intravitreal bevacizumab at doses of 1.25 mg or 2.5 mg. In addition, our results suggest the need for at least three injections a year to maintain the BCVA results. © Springer-Verlag 2009

Bevacizumab intravítreo primario (Avastin) para los resultados del edema macular diabético del Grupo de Estudio Panamericano de Colaboración Retina a los 6 meses de seguimiento

Purpose: To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME). Design: Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME. Participants: We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventyeight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7 9.3 years were included in this analysi

Primary intravitreal bevackumab (Avastin) for diabetic macular edema - Results from the Pan-American Collaborative Retina Study Group at 6-month follow-up

Purpose: To report the 6-month anatomic and best-corrected visual acuity (BCVA) response after primary intravitreal bevacizumab (Avastin) in patients with diabetic macular edema (DME).Design: Interventional retrospective multicenter study at 6 centers from 6 countries of patients with DME.Participants: We reviewed the clinical records of 88 consecutive patients (110 eyes) with DME. Seventy-eight eyes of 64 consecutive patients with a minimum follow-up of 6 months and mean age of 59.7--9.3 years were included in this analysis.Intervention: Patients were treated with at least one intravitreal injection of 1.25 mg or 2.5 mg of bevacizumab and underwent Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. Repeated- measures analysis of variance was used to compare mean values.Main Outcome Measures: Changes in BCVA, OCT, and FA.Results: Mean follow-up was 6.31 +/- 0.81 months (range, 6-9). Sixteen (20.5%) eyes needed a second injection at a mean of 13.8 weeks (range, 4-28), and 6 eyes needed a third injection (7.7%) at a mean of 11.5 weeks (range, 5-20). the mean baseline BCVA was 0.87 (logarithm of the minimum angle of resolution), and the final mean BCVA was 0.6, a difference that was statistically significant (P = 2 ETDRS lines of BCVA, and 3 (3.8%) decreased :2 ETDRS lines of BCVA. Mean central macular thickness at baseline by OCT was 387.0 +/- 182.8 mu m and decreased to a mean of 275.7 +/- 108.3 at end of follow-up (P < 0.0001). No ocular or systemic adverse events were observed.Conclusions: Primary intravitreal bevacizumab at doses of 1.25 to 2.5 mg seem to provide stability or improvement in VA, OCT, and FA in DME at 6 months. Follow-up is still short to make any specific treatment recommendations; however, the results appear promising. Evaluation in a multicenter randomized controlled clinical trial with longer follow-up is needed.Clin Oftalmol Ctr Caracas, Retina & Vitreous Serv, Caracas 1010A, VenezuelaHosp Dr Luis Sanchez Bulnes, Asociac Evitar Ceguera Mexico, Mexico City, DF, MexicoInst Cirugia Ocular, San Jose, Costa RicaUniversidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, BrazilUniv Puerto Rico, San Juan, PR 00936 USAUniversidade Federal de São Paulo, Dept Oftalmol, Inst Visao, São Paulo, BrazilWeb of Scienc