Sanjeeb Bhandari1, David Squirrell2, Vuong Nguyen3, Nancy Wang4, Jane M Wells5, Terence Tan6, Rachel Barnes7, Richard Barry8, Daniel Barthelmes3,9, Mark Gillies3. 1. Save Sight Institute, Discipline of Ophthalmology and Eye Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. sbha5189@uni.sydney.edu.au. 2. Auckland District Health Board, Auckland, New Zealand. 3. Save Sight Institute, Discipline of Ophthalmology and Eye Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. 4. Department of Ophthalmology, The University of Auckland, Auckland, New Zealand. 5. Canberra Hospital and Health Services, Canberra, ACT, Australia. 6. Marsden Eye Specialists, Sydney, NSW, Australia. 7. Retina Specialists, Auckland, New Zealand. 8. Blink Eye Clinic, Canberra, ACT, Australia. 9. Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Abstract
OBJECTIVES: This study evaluated the 1-year treatment outcomes of bevacizumab for diabetic macular oedema (DMO) in routine clinical practice. METHODS: A retrospective analysis was performed on 298 eyes of 220 patients with DMO that received intra-vitreal bevacizumab between 1 September 2013 and 31 August 2018 that were tracked by a prospectively designed, web-based observational registry-the Fight Retinal Blindness! Registry. RESULTS: The mean visual acuity (95% confidence interval [CI]) at 1-year was 3 (2, 5) letters better than a mean (SD) of 68 (15) letters at study entry. Nearly a quarter of eyes achieved ≥20/40. Eyes presenting with better vision (≥20/40) tended to maintain that vision during the period of observation, whereas those presenting with worse vision (<20/40) gained a mean (95% CI) of 9 (5, 13) letters. A mean reduction in the macular thickness was observed over the study period with the central subfield improving by 29 µm (95% CI 17, 40) from a mean (SD) of 402 (109) µm at study entry. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 7 (4, 9) bevacizumab injections. Sixty-two eyes, ~20%, that started with bevacizumab changed to either another VEGF inhibitor or steroid (triamcinolone) during the period of observation. This did not lead to functional improvement for eyes changed to either ranibizumab or aflibercept despite a further reduction in macular thickness. An improvement in vision and reduction in macular thickness was noted in the 13 eyes that subsequently received triamcinolone. Approximately 10% of eyes dropped out over 12 months, even though their mean visual acuity had improved by seven letters from the initial visit. CONCLUSIONS: Bevacizumab is an effective treatment for DMO in unselected populations.
OBJECTIVES: This study evaluated the 1-year treatment outcomes of bevacizumab for diabetic macular oedema (DMO) in routine clinical practice. METHODS: A retrospective analysis was performed on 298 eyes of 220 patients with DMO that received intra-vitreal bevacizumab between 1 September 2013 and 31 August 2018 that were tracked by a prospectively designed, web-based observational registry-the Fight Retinal Blindness! Registry. RESULTS: The mean visual acuity (95% confidence interval [CI]) at 1-year was 3 (2, 5) letters better than a mean (SD) of 68 (15) letters at study entry. Nearly a quarter of eyes achieved ≥20/40. Eyes presenting with better vision (≥20/40) tended to maintain that vision during the period of observation, whereas those presenting with worse vision (<20/40) gained a mean (95% CI) of 9 (5, 13) letters. A mean reduction in the macular thickness was observed over the study period with the central subfield improving by 29 µm (95% CI 17, 40) from a mean (SD) of 402 (109) µm at study entry. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 7 (4, 9) bevacizumab injections. Sixty-two eyes, ~20%, that started with bevacizumab changed to either another VEGF inhibitor or steroid (triamcinolone) during the period of observation. This did not lead to functional improvement for eyes changed to either ranibizumab or aflibercept despite a further reduction in macular thickness. An improvement in vision and reduction in macular thickness was noted in the 13 eyes that subsequently received triamcinolone. Approximately 10% of eyes dropped out over 12 months, even though their mean visual acuity had improved by seven letters from the initial visit. CONCLUSIONS: Bevacizumab is an effective treatment for DMO in unselected populations.
Authors: Sanjeeb Bhandari; Vuong Nguyen; Adrian Hunt; Pierre-Henry Gabrielle; Francesco Viola; Hemal Mehta; Les Manning; David Squirrell; Jennifer Arnold; Ian L McAllister; Daniel Barthelmes; Mark Gillies Journal: Eye (Lond) Date: 2022-05-04 Impact factor: 4.456