Frank C. Schlichtenbrede

Intravitreal Bevacizumab for Filtering Surgery

Background: It was the aim of this study to report on the intravitreal use of bevacizumab as antiproliferative agent in combination with filtering surgery. Methods: The clinical interventional case series study included 2 patients (2 eyes) who underwent standard antiglaucomatous penetrating filtering surgery combined with an intravitreal application of 1.5 mg bevacizumab. The intraocular pressure was elevated due to an intravitreal triamcinolone injection as treatment of exudative age-related macular degeneration (patient No. 1) or due to neovascular glaucoma (patient No. 2) after an ischemic retinal branch vein occlusion. Results: At 4 and 12 weeks after surgery, intraocular pressure was reduced in both patients to 10 and 14 mm Hg with functioning filtering blebs. Conclusions: Intravitreal bevacizumab may potentially be helpful as addition to antiglaucomatous filtering surgery, particularly in neovascular glaucoma.

Intravitreal bevacizumab for retinopathy of prematurity.

BACKGROUND To evaluate the therapeutic effect of a single intravitreal injection of bevacizumab for treatment of threshold retinopathy in retinopathy of prematurity (ROP). METHODS The retrospective study consisted of all infants who developed threshold ROP in fundus zone I or zone II and who consecutively received an intravitreal injection of bevacizumab (0.375 mg, 0.03 mL) in local anesthesia. RESULTS Twelve infants (23 eyes) were included into the study. The mean birth weight was 625±187 g (mean±standard deviation; range: 450-810 g), mean gestational age was 25.1±1.4 weeks (range: 24.0-28.7 weeks), mean age at the time of intervention was 38.1±3.7 gestational weeks (range: 32.1-45.6 weeks), and mean follow-up was 30.4±25.9 weeks. Three children (6 eyes) showed aggressive posterior ROP. After the injection, all eyes showed a regression of plus disease within 2-6 days, a decrease in pupillary rigidity, a resolution of any tunica vasculosa lentis, and a complete regression of the retinal neovascularization within 2-3 weeks. In none of the children a second intravitreal injection of bevacizumab was performed. CONCLUSIONS A single intravitreal bevacizumab injection of 0.375 mg in 0.03 mL appears to be potentially helpful for the therapy of threshold ROP avoiding side effects of conventional retinal laser coagulation such as irreversible retinal scarring. Long-term effects and side effects may be assessed in future prospective randomized trials.

Choroidal thickness in age-related macular degeneration.

Purpose: To examine choroidal thickness in age-related macular degeneration (AMD). Methods: The hospital-based case series study included patients with nonexudative or exudative AMD as study group, and the control group consisted of subjects with a normal fundus. Choroidal thickness was measured by enhanced depth imaging of spectral domain optical coherence tomography. Results: The study group (126 patients; 204 eyes) included a nonexudative subgroup (n = 50 eyes) and an exudative subgroup (n = 154 eyes), differentiated into eyes with mostly retinal pigment epithelium detachment (n = 35), mostly retinal edema (n = 36), and a subretinal fibrotic scar (n = 83). For 29 patients with unilateral AMD, contralateral normal eyes were compared with affected eyes. The control group consisted of 189 patients (228 eyes). Comparing choroidal thickness between the affected eyes and contralateral unaffected eyes in patients with unilateral AMD revealed no statistically significant differences (all P > 0.20). After adjusting for age and refractive error, subfoveal choroidal thickness was not significantly (all P > 0.10) related with AMD neither as a whole nor with the nonexudative or exudative AMD subgroup nor with the single exudative AMD subtypes (except for the subretinal fibrotic scar subgroup; P = 0.03). Correspondingly, choroidal thickness at a horizontal distance of 1000 &mgr;m from the fovea was not significantly (all P ≥ 0.30) associated with any subgroup of AMD. In binary regression analysis, the presence of AMD or of its subtypes (except for subretinal fibrotic scar type) was not significantly (all P ≥ 0.20) associated with subfoveal or parafoveal choroidal thickness after adjustment for age and refractive error. After matching for age, refractive error, and axial length, study group and control group did not differ significantly (all P ≥ 0.25) in foveal or parafoveal choroidal thickness measurements. Conclusion: After adjusting for age and refractive error, AMD, neither in its nonexudative form nor exudative form, was significantly associated with a marked thinning or thickening of the choroid in the foveal and parafoveal region.

Intravitreal low-dosage bevacizumab for retinopathy of prematurity

To report on the therapeutic effect of intravitreal low‐dose bevacizumab for treatment for retinopathy of prematurity (ROP).

INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION

BACKGROUND AND OBJECTIVE To evaluate the effect of intravitreal bevacizumab on visual acuity in patients with myopic choroidal neovascularization. PATIENTS AND METHODS The retrospective case series study included 13 patients with myopic choroidal neovascularization who received three intravitreal injections of 1.5 mg of bevacizumab. RESULTS At 1, 3, and 6 months after the first injection, mean visual acuity improved significantly from 0.63 +/- 0.41 logarithm of the minimum angle of resolution units (LogMAR) to 0.39 +/- 0.22 (P< .001), 0.47 +/- 0.49 (P= .002), and 0.52 +/- 0.49 LogMAR (P = 0.009), respectively. The increase in visual acuity was correlated with a significant decrease in central retinal thickness (P = .003) as measured by optical coherence tomography. Mean intraocular pressure did not change significantly (P> .05) during follow-up. CONCLUSION Intravitreal injections of bevacizumab may be a therapeutic option for exudative myopic macular degeneration.

Intravitreal Bevacizumab versus Triamcinolone Acetonide for Exudative Age-Related Macular Degeneration

Background: To compare an intravitreal high-dose injection of triamcinolone acetonide with an intravitreal injection of bevacizumab for the treatment of progressive exudative age-related macular degeneration (AMD). Method: The comparative nonrandomized retrospective clinical interventional study included 305 patients with progressive AMD, divided into a bevacizumab group of 36 patients (1.5 mg bevacizumab) and a triamcinolone group of 269 patients (about 20 mg triamcinolone). All patients were consecutively included, in the first phase of the study for triamcinolone, and in the second phase of the study for bevacizumab. The mean follow-up was 8.5 ± 6.8 months (2–35.7 months). Results: In the bevacizumab group, best visual acuity increased significantly (p < 0.001) by 3.2 ± 3.4 Snellen lines, with 25 (69%) eyes and 21 (58%) eyes, improving by at least 2 and 3 Snellen lines, respectively. In the triamcinolone group, the visual acuity change was not statistically significant for any specific follow-up examination within the first 3 months. The maximal increase in visual acuity, the visual acuity change at 2 months after injection and the percentage of patients with an improvement by at least 2 and 3 Snellen lines were significantly (p < 0.001) higher in the bevacizumab group than in the triamcinolone group. Intraocular pressure increased significantly (p < 0.001) in the triamcinolone group and did not change significantly (p = 0.47) in the bevacizumab group. Conclusion: In exudative AMD, intravitreal bevacizumab (1.5 mg) compared with intravitreal triamcinolone acetonide (about 20 mg) results in a higher improvement of visual acuity and does not markedly influence intraocular pressure within 2 months after injection.

Choroidal Thickness in Nonarteritic Anterior Ischemic Optic Neuropathy

PURPOSE To examine choroidal thickness in nonarteritic anterior ischemic optic neuropathy (AION). DESIGN Retrospective case control study. METHODS In the eye clinic of the University Medical Center in Mannheim, Germany, we studied a group that consisted of patients with nonarteritic AION and a control group that consisted of individuals with normal fundus. Choroidal thickness was measured by the enhanced-depth imaging of spectral-domain optical coherence tomography. The main outcome measure was choroidal thickness. RESULTS The study group consisted of 20 patients: 11 patients with acute nonarteritic AION and an unaffected contralateral eye and 9 patients with acute unilateral nonarteritic AION and previously nonarteritic AION in the contralateral eye. The control group consisted of 58 patients (58 eyes). In multivariate analysis, thinner subfoveal choroidal thickness was associated with the diagnosis of nonarteritic AION (P = 0.001; regression coefficient B, -55.1), after adjusting for age (P < 0.001) and refractive error (P = 0.20). Similarly, unaffected eyes contralateral to eyes with acute nonarteritic AION as compared to control eyes showed thinner subfoveal choroidal thickness (P = 0.037) after adjusting for age (P = 0.001) and refractive error (P = 0.06). In a reverse manner, nonarteritic AION was associated with thinner subfoveal choroidal thickness (P = 0.007) after adjusting for age, optic disc diameter, gender, and refractive error. CONCLUSIONS Eyes affected by nonarteritic AION and unaffected contralateral eyes showed significantly thinner macular choroids than eyes of a control group after adjusting ocular and systemic parameters. A thin choroid may be added to the diagnostic features of nonarteritic AION. Future studies may examine the pathophysiologic meaning of the finding.

Combined intravitreal bevacizumab and triamcinolone in exudative age‐related macular degeneration

Acta Ophthalmol. 2010: 88: 630–634

Early refractive outcome after intravitreous bevacizumab for retinopathy of prematurity.

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Choroidal Thickness in Open-angle Glaucoma.

Purpose:To examine choroidal thickness in open-angle glaucoma. Methods:The hospital-based case series study included a study group with patients with open-angle glaucoma and a control group. Choroidal thickness was measured by enhanced depth imaging by spectral domain optical coherence tomography. Results:The study group included 39 patients (71 eyes) and the control group consisted of 189 patients (228 eyes) with no significant difference between both groups in age (P=0.16) and refractive error (P=0.07). Choroidal thickness in the foveal region (P=0.18), at a distance of 1000 &mgr;m from the fovea (P=0.39), 2000 &mgr;m from the fovea (P=0.46), and 2500 &mgr;m from the fovea (P=0.53) did not vary significantly between both groups. In multivariable analysis with adjustment for age and refractive error, choroidal thickness at the fovea [P=0.12; regression coefficient B: minus−8.60; 95% confidence interval (CI): −19.3, 2.1], at a horizontal distance of 1000 &mgr;m from the fovea (P=0.30; regression coefficient B: −4.98; 95% CI: −14.3, 4.4), 2000 &mgr;m from the fovea (P=0.20; regression coefficient B: −20.9; 95% CI: −53.2, 11.3), and 2500 &mgr;m from the fovea (P=0.45; regression coefficient B: −2.70; 95% CI: −9.67, 4.27) was not significantly associated with the diagnosis of glaucoma. In binary regression analysis with adjustment for age and refractive error, presence of glaucoma was significantly associated neither with subfoveal choroidal thickness [P=0.12; odds ratio (OR): 0.997; 95% CI: 0.993, 1.001] nor with choroidal thickness at a horizontal distance of 1000 &mgr;m from the fovea (P=0.47; OR: 0.998; 95% CI: 0.993, 1.002), 2000 &mgr;m from the fovea (P=0.23; OR: 0.997; 95% CI: 0.993, 1.002), or 2500 &mgr;m from the fovea (P=0.46; OR: 0.998; 95% CI: 0.992, 1.004). Conclusions:After adjusting for age and refractive error, open-angle glaucoma was not significantly associated with a marked thinning or a thickening of the choroid in the foveal and parafoveal region.