J Korean Ophthalmol Soc.  2010 May;51(5):700-706.

The Effects of Intravitreal Bevacizumab Injection According to the Type of Diabetic Macular Edema

• Jeong JH
• Kim ES
• Lee JK
• Moon NJ
• Cho HK

Abstract

PURPOSE
To investigate the effects of intravitreal bevacizumab injection on diabetic macular edema (DME) of different types classified using Optical Coherence Tomography (OCT).
METHODS
A total of 82 eyes with refractory DME were enrolled. The DME was classified into diffuse, cystoid, or serous type based on the OCT findings. All cases had received an intravitreal injection of 1.25 mg bevacizumab each month for three months. Foveal thickness, macular volume, and best corrected visual acuity (BCVA) were measured before and one month after the injection, and the interval changes in these parameters were compared.
RESULTS
The types of DME were classified as follows: diffuse macular edema 50%, cystoid macular edema 31.7%, and serous macular detachment 18.3%. Foveal thickness and total macular volume after intravitreal bevacizumab injection decreased in all types, and the cystoid and serous types showed better response than did the diffuse type with regard to foveal thickness. However, there were no significant differences in the extent of the change in total macular volume or BCVA among the three types of DME.
CONCLUSIONS
There were differences in the therapeutic effects of intravitreal bevacizumab injection among the different types of DME classified using OCT. These differences may be associated with the stabilizing effect of the bevacizumab. This effect was stronger with regard to vascular permeability, the primary factor in the pathogenesis of the cystic and serous types, than with regard to leakage from the microaneurysm, the primary factor in the pathogenesis of the diffuse type. Practical application of bevacizumab to eyes with different DME types will help in further evaluating intravitreal bevacizumab injection as a treatment option for DME.

Keyword

Diabetic macular edema; Intravitreal bevacizumab injection; OCT type

MeSH Terms

Antibodies, Monoclonal, Humanized
Capillary Permeability
Eye
Intravitreal Injections
Macular Edema
Tomography, Optical Coherence
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized

Figure

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  Figure 1. An analysis of the foveal thickness before and 1 month after the third intravitreal bevacizumab injection. Foveal thickness significantly decreased in every type (Wilcoxon's signed rank test, p=.02, p<.001, p=.001, with p<.05 regarded as significant). And the extent of changes in types of cystoid macular edema and serous macular detachment was greater than in diffuse macular edema type (Mann-Whitney U test p=.002, with p<.05 regarded as significant).

• 

  Figure 2. An analysis of total macular volume before and 1 month after the third intravitreal bevacizumab injection. Total macular volume was significantly decreased in every type (Wilcoxon's signed rank test, p=.01, p= .001, p=.02, with p<.05 regarded as significant). But there were no significant differences for the extent of changes among the three types of diabetic macular edema (Mann-Whitney U test p>.05, with p<.05 regarded as significant).

• 

  Figure 3. An analysis of the best corrected visual acuity (BCVA) before and 1 month after the third intravitreal bevacizumab injection. There were neither significant differences for changes of BCVA in the three types of macular edema nor for the extent of changes among the three types of diabetic macular edema (Wilcoxon's signed rank test p>.05, Mann-Whitney U test p>.05, with p<.05 regarded as significant).

Reference

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