Intravitreal Bevacizumab AvastinTM for the Management of Refractory Pseudophakic CME: 12months Follo

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Intravitreal Bevacizumab (AvastinTM) for the
Management of Refractory Pseudophakic CME
12-months Follow-Up
J. Fernando Arevalo, MD FACS
Clínica Oftalmológica Centro Caracas
Caracas, Venezuela
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Bevacizumab Refractory Pseudophakic CME
Co-authors

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

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The authors acknowledge no
financial interestThis presentation includes
the off-label use of Bevacizumab (AvastinTM)
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Bevacizumab Refractory 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 Refractory Pseudophakic CME
Introduction

• Studies have demonstrated the usefulness of ITV
  bevacizumab
• CNV secondary to AMD
• Macular edema secondary to CRVO
• Pseudophakic CME
• DME
• INV, NVG RN secondary to PDR

B
C
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Bevacizumab Refractory Pseudophakic CME
Objective

• To determine the 12-months feasibility, safety
  and clinical effect of IVT bevacizumab in
  patients with refractory CME after cataract
  surgery

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Bevacizumab Refractory Pseudophakic CME Methods

• Interventional retrospective multicenter study of
  eyes with refractory pseudophakic CME treated
  with off-label IVT bevacizumab (AvastinTM)
• 36 eyes of 31 consecutive patients with a minimum
  follow-up of six months
• Mean follow-up of 54.3 weeks (range 24 to 90
  weeks)
• Mean age was 69.5 years (range 50-87)
• 64.5 were female

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Table 1 Patients Demographics
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Bevacizumab Refractory Pseudophakic CME Methods

• 21 cases (58.3) were treated with a dose of 1.25
  mg
• 15 cases (41.7) were treated with a dose of 2.5
  mg

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Bevacizumab Refractory Pseudophakic CME BCVA
Results

• The mean baseline BCVA was logMAR 0.92 (20/160
  range 2.0 - 0.2)
• The mean final BCVA was logMAR 0.55
  (20/63range 1.3 - 0.0)
• p lt 0.0001

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Table 2 BCVA Results
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Bevacizumab Refractory Pseudophakic CME OCT
Results

• The baseline mean central macular thickness was
  456.2 µm (range 208-784)
• The final central macular thickness was 262.9 µm
  (range 142-513)
• p lt 0.0001

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Bevacizumab Refractory Pseudophakic CME
Reinjections

• 5 (13.9) eyes needed a second injection at a
  mean of 17.4 weeks (range 6-26)
• 9 (25) eyes needed a third injection at a mean
  of 18.6 weeks (range 7-45)
• 5 (13.9) eyes needed a fourth injection at a
  mean of 17.5 weeks (range 11-24)
• 1 (25) eye needed a fifth injection at a mean of
  14.5 weeks (range 12-18)
• The mean interval between injections was 17.6
  weeks (range 6-45 weeks)

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Case 1. 2.5 mg Intravitreal Bevacizumab and
Refractory Pseudophakic CME

• A 64-year-old man with refractory pseudophakic
  CME presented with a VA of 20/160 in his right
  eye

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Before Bevacizumab VA 20/160
1 month later VA 20/63
6 months later VA 20/40
12 months later VA 20/32
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Bevacizumab Refractory 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, RPE changes, epiretinal
  membrane formation, and non-reversible macular
  changes with permanent visual loss) can be
  reduced or avoided

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Bevacizumab Refractory Pseudophakic CME
Conclusions

• In the future, this new treatment modality could
  be established as an alternative treatment for
  refractory CME after cataract surgery with a
  rapid reduction in macular edema and improvement
  in VA with no significant short-term
  complications
• Furthermore, bevacizumab may be the only option
  in patients who are known steroid responders and
  who are unresponsive to NSAIDs