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Primary nonresponse to intravitreal bevacizumab in refractory diabetic macular edema

Session Details

Session Title: Vascular Diseases and Diabetic Retinopathy

Session Date/Time: Friday 18/09/2015 | 11:00-12:30

Paper Time: 12:20

Venue: Calliope

First Author: : E.Rishi INDIA

Co Author(s): :    P. Rishi   V. Koundanya           

Abstract Details

PURPOSE:Anti VEGF (Vascular endothelial growth factor) nonresponse in diabetic macular edema (DME) is not studied well .This study aimed to analyze the patients of refractory DME with primary nonresponse to intravitreal bevacizumab (IVB). It also aimed to study the effect of intravitreal corticosteroids in such eyes.

Setting:

Retrospective, interventional case study done at a tertiary ophthalmic centre in South India

Methods:

It is a retrospective, interventional case study of 16 eyes of 10 patients seen from January 2007 to July 2014 at a tertiary eye care centre. All these patients had refractory DME who were labelled as non responders for IVB injection. IVB non response was defined as +/- 100 micron change in central retinal thickness on OCT following 2 consecutive IVB injections at an interval of 1 month. The systemic ,OCT and FFA features were studied. 11 eyes recieved intravitreal steroid either traimcinolone acetate or dexamethasone implant. Patients were followed at one monthly interval with OCT and the response was assessed in terms of central foveal thickness, type of macular oedema and intraocular pressure

Results:

16 eyes of 10 patients were examined, where 15 were male and 1 female. Mean age of 60.5 + 5.08 years ( 54 - 70 years). The mean duration of Diabetes was 14.3 + 7.93 years. Mean foveal thickness before IVB, after 2 doses of IVB and after the last steroid injection were 591.8 + 147.25 microns (405 - 949 microns), 608.87 + 158.25 microns (430 – 1027 microns) and 282.54 + 126.68 microns (180 – 543 microns, p =0.001 ) respectively. The mean best corrected visual acuity before IVB, after 2 doses of IVB and after the last steroid injection were 0.63 + 0.41, 0.61 + 0.34, 0.64 + 0.48 respectively. 12 (75%) eyes had large cystic changes at the fovea, 4 (25%) eyes also had neurosensory detachment (NSD). All patients underwent macular laser prior to IVB injections. 10(62.5%) eyes had undergone panretinal photocoagulation earlier. Average postprandial blood sugar was 165.56 mg/dl (120 – 294 mg/dl). 8 (80%) patients had associated systemic hypertension and hyperlipidemia. 5 (31.25%) eyes were on Antiglaucoma medications at the last followup due to steroid response.

Conclusions:

: IVB nonreponders do exist in clinical scenario where OCT shows large cystoids changes and intravitreal steroid may be the alternate mode of treatment. Anatomical success is seen with the use of steroid but functional improvement was not noted.

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