TY - JOUR
T1 - Comparison of two doses of primary intravitreal bevacizumab (Avastin) for diffuse diabetic macular edema
T2 - Results from the Pan-American Collaborative Retina Study Group (PACORES) at 12-month follow-up
AU - Arevalo, Fernando
AU - Sanchez, Juan G.
AU - Fromow-Guerra, Jans
AU - Wu, Lihteh
AU - Berrocal, Maria H.
AU - Farah, Michel E.
AU - Cardillo, Jose
AU - Rodríguez, Francisco J.
N1 - Funding Information:
Supported in part by the Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela. J.F.Arevalo . J. G. Sanchez Retina and Vitreous Service, Clinica Oftalmológica Centro Caracas, Caracas, Venezuela J. Fromow-Guerra Asociacion Para Evitar la Ceguera en Mexico, Hospital Dr. Luis Sanchez Bulnes, Mexico, Mexico
Funding Information:
A recetly published multi-center study, funded by the National Eye Institute and conducted through the Diabetic Retinopathy Clinical Research Network, studied 840 eyes of 693 subjects with DME involving the fovea and with visual acuity of 20/40 to 20/320. This 2-year study demonstrated that focal/grid photocoagulation is more effective and has fewer side effects than 1-mg or 4-mg doses of preservative-free intravitreal triamcinolone for most patients with DME who have characteristics similar to the cohort in this clinical trial. Though the evidence currently supports focal/grid photocoagulation as the most effective treatment, the authors commented that combining laser therapy with corticosteroids might prove useful [35]. Therefore, the same may be true for anti-VEGF therapies, and combination therapies should be considered. However, some unresolved issues such as the ideal regimen, duration of treatment, potential of combination treatments, and safety concerns with long-term VEGF inhibition deserve further investigation.
PY - 2009/6
Y1 - 2009/6
N2 - 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<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 μm at baseline to 295.11±91.5 μm 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.
AB - 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<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 μm at baseline to 295.11±91.5 μm 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.
UR - http://www.scopus.com/inward/record.url?scp=67349157689&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67349157689&partnerID=8YFLogxK
U2 - 10.1007/s00417-008-1034-x
DO - 10.1007/s00417-008-1034-x
M3 - Research Article
C2 - 19189118
AN - SCOPUS:67349157689
SN - 0721-832X
VL - 247
SP - 735
EP - 743
JO - Graefe's Archive for Clinical and Experimental Ophthalmology
JF - Graefe's Archive for Clinical and Experimental Ophthalmology
IS - 6
ER -
