After injection

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Efficacy of Vitreous Injection of Bevacizumab of
Pseudophakic CME
Before injection
Yoshihide Nakai, Kyoko Bessyo Yuko Shono,
Yoshimasa Nakai TsuJapan
After injection
Financial Interest Disclosure None
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Purpose
If left untreated, CME after cataract surgery
may leave permanent visual inpairment. The
efficacy of vitreous injection of bevacizumab
for this disease was investigated.
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Method
12 patients with CME after cataract surgery that
did not respond to nonsteroid anti-inflammatory
drugs (NSAIDs) were administered. Bevacizumab
1.25mg as vitreous injection between 6 and
12weeks after surgery. The thickness of the
macula (OCT,cirrus) and the visual acuity were
examined before and after injection (1week, 1
and 3months).
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Bevacizumab 1.25mg vitreous injection
The surgical procedure shows the way of which
bevacizumab is injected into a vitreous. I
performed a surgery after sterilization and
ocular anesthesia. Its injected into a vitreous
using 30G needle.The bevacizumab injected was
1.25mg.After vitreous injection, the occular
pressure was checked and ended the procedure.
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Bevacizumab 1.25mg vitreous injection
12patients(612weeks after surgery) CME after
cataract surgery that did not respond NSAIDs
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Results
The mean BCVA was 20/60(20/100-20/35) before
injection of bevacizumab, and it improved to
20/30(20/70-20/20) at 1week, 20/25(20/50-20/20)
at 1month, and 20/20 at 3months after
injection. The thickness of the macula improved
from a mean pre-injection value of
765µm (511-892µm) to 590µm (391-685µm) at
1week,371µm(287-509µm) at 1month, and 225µm
(190-310µm) at 3months after injection
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The visual acuity, before and after injection
BCVA
1week after injection
1 month after injection
3 month after injection
before Bevacizumab injection
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Macula Thickness, before and after injection
Macula Thickness
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Discussion
Cystoid macular edema (CME) occur after
phacoemulsification and IOL insertion
surgery. When a FA check was done, its frequency
was 70.Its healing is almost naturally, but
with 2 visual acuity cut-down. If CME continues
for several months, the change in macula becomes
irreversible and visual acuity cut down
continues. There are steroid and nonsteroidal
antiinflammatory agents (NSAIDs) treatment,
but there are ineffectiveness case for both.
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Discussion-continued
There is an action which restrains
vascular endothelial growth factor (VEGF) but
bevacizumab when used it also has the
effect which restrains vasopermeability. An
inflammation forms after surgery, and blood
retinal barrier (BRB) fails because of it, and
vasopermeability of macula increases, and CME
forms. I think bevacizumab restrained this
vasopermiability and made CME to be healed.
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Conclusion
In cases of CME after cataract surgery that do
not respond to steroid and NSAIDs, vitreous
injection of bevacizumab is an effective
therapy to improve visual acuity.