Primary Intravitreal Bevacizumab AvastinTM for the Management of Pseudophakic Cystoid Macular Edema

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Primary Intravitreal Bevacizumab (AvastinTM) for
the Management of Pseudophakic Cystoid Macular
Edema (CME) A Pilot Study
J. Fernando Arevalo, MD FACS Clínica
Oftalmológica Centro Caracas The Arevalo-Coutinho
Foundation for Research in Ophthalmology Caracas,
Venezuela
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Bevacizumab Pseudophakic CME Co-authors

• Rafael A. Garcia-Amaris, MD
• Jose A. Roca, MD
• Juan G. Sanchez, MD
• Maria H. Berrocal, MD
• Mauricio Maia, MD

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The authors acknowledge no
financial interest on the matter of this
presentationThis presentation includes the
off-label use of Bevacizumab (AvastinTM)
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Bevacizumab Pseudophakic CME Introduction

• Incidence
• Angiographic CME up to 20
• Clinically significant CME 0-13
• In most patients, CME resolves spontaneously,
  with 50 to 75 of patients achieving improved
  vision within 6 months
• Some patients suffering permanent visual morbidity

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Bevacizumab Pseudophakic CME Introduction

• Studies demonstrated the usefulness of ITV
  bevacizumab for
• CNV secondary to ARMD
• Macular edema secondary to CRVO Diabetic
  retinopathy
• Refractory pseudophakic CME
• INV, NVG RN secondary to PDR

B
C
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Bevacizumab Pseudophakic CME Objective

• To determine the 6-months feasibility, safety and
  clinical effect of primary intravitreal
  bevacizumab in patients with CME after cataract
  surgery

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Bevacizumab Pseudophakic CME Methods

• Interventional retrospective multicenter study of
  eyes with pseudophakic CME treated with off-label
  IVT bevacizumab (AvastinTM)
• 28 eyes of 25 consecutive patients with a minimum
  follow-up of six months
• Mean follow-up of 32 weeks (range 24-52)
• Mean age was 69 years (range 50-87)
• 68 were female

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Bevacizumab Pseudophakic CME Table 1
Patients Demographics
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Bevacizumab Pseudophakic CME Methods

• 16 cases (57.1) were treated with a dose of 1.25
  mg
• 12 cases (42.9) were treated with a dose of 2.5
  mg

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Bevacizumab Pseudophakic CME BCVA Results

• The mean baseline BCVA was logMAR 0.92 (range
  2.0 0.2)
• The mean final BCVA was logMAR 0.50 (range 1.3
  0.0)
• p lt 0.0001

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Bevacizumab Pseudophakic CME BCVA Results
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Bevacizumab Pseudophakic CME OCT Results

• The baseline mean central macular thickness was
  466.3 µm (range 208-784)
• The final central macular thickness was 264.5 µm
  (range 176-513)
• p lt 0.0001

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Bevacizumab Pseudophakic CME Reinjections

• 18 (28.6) eyes needed a second injection at a
  mean of 14.9 weeks (range 5-12)
• 4 (14.3) eyes needed a third injection at a mean
  of 8.8 weeks (range 7-12)
• No difference was observed between doses of
  bevacizumab used
• No systemic or ocular adverse events were observed

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Case 1. 2.5 mg Intravitreal Bevacizumab and
Pseudophakic CME

• A 75-year-old woman with pseudophakic CME
  presented with a VA of 20/100 in her left eye

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Before Bevacizumab VA 20/100
1 month later VA 20/40
3 months later VA 20/32
6 months later VA 20/25
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Bevacizumab Pseudophakic CME Conclusions

• Bevacizumab modifies the natural history of
  macular edema by stabilizing the BRB in a rapid
  and effective form, facilitating fluid
  reabsorption in the retina and achieving a
  striking regression of CME with a remarkable
  decrease of foveal thickness
• Therefore, complications of chronic CME (serous
  macular detachment, EPR changes, epiretinal
  membrane formation, and non-reversible macular
  changes with permanent visual loss) can be
  reduced or avoided

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Bevacizumab Pseudophakic CME Conclusions

• This new treatment could be established as part
  of the armamentarium for the treatment of
  (refractory or not) CME after cataract surgery
  with a rapid reduction in macular edema and
  improvement in VA with no significant short-term
  (at least 6 months) complications
• Furthermore, bevacizumab may be the only option
  in patients who are known steroid responders and
  who are unresponsive to NSAIDs
• Further studies are needed