Ozgur Artunay

Intravitreal Bevacizumab (Avastin) Injection in Retinitis Pigmentosa

Purpose: To evaluate and report the effectiveness, visual, anatomical, and clinical outcome of intravitreal bevacizumab (Avastin) injection in patients with retinitis pigmentosa (RP). Methods: Our prospective study included 13 eyes of 7 patients (4 women and 3 men) in the age range of 25–69 years (mean 44.14 years) with cystoid macular edema (CME) secondary to RP. Intravitreal bevacizumab at a dose of 1.25 mg/0.05 ml was injected via a 28-gauge needle. The response rate to treatment was monitored functionally by visual acuity assessment and anatomically using the optical coherence tomography. Results: The baseline mean central macular thickness was 370.15 μ m (range 245–603 μ m. The central macular thickness decreased to 142.53 μ m (range 124–168 μ m) after bevacizumab injections. The pre- and post-treatment visual acuity ranges were 5/400–20/100 and 20/200–20/63, respectively. Conclusions: Our data reveal that intravitreal bevacizumab administration is effective for the treatment of CME in RP. Further studies with a larger population and longer follow-up period are warranted to assess the efficacy of the treatment.

Intravitreal Ranibizumab in the Treatment of Cystoid Macular Edema Associated With Retinitis Pigmentosa

PURPOSEnTo report and evaluate the anatomic, clinical, and visual acuity response after intravitreal ranibizumab (IVR) injection in patients with cystoid macular edema (CME) due to retinitis pigmentosa (RP).nnnMETHODSnThis study included 30 eyes of 30 patients with RP who had persistent CME at least 6 months despite medication with acetazolamide. Fifteen eyes of 15 eligible patients were treated with 0.5 mg IVR injection (treatment group). Fifteen eyes of 15 patients with the same characteristics who refused treatment were accepted as control group. The primary outcome of the study (morphologic restitution) was the complete or significant resolution of cystoid space on optic coherence tomography (OCT) without relapse or complication at 6 months. The serial changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured.nnnRESULTSnThirteen eyes (86.6%) in the treatment group had significant resolution of CME at 6 months after single IVR injection. The difference between the 2 groups in BCVA was not statistically significant (P > 0.05). The baseline mean +/- SD CFT for the treatment and control groups were 478 +/- 88 microm and 469 +/- 75 microm, respectively (P > 0.05). At 6 months after treatment, the mean +/- SD CFT of the treatment group improved to 272 +/- 65 microm whereas that in the control group was 480 +/- 92 microm (P < 0.001).nnnCONCLUSIONSnThis investigation indicated that IVR may provide a new therapeutic approach for the treatment of CME secondary to RP. No adverse event was found to be associated with the treatment. Continued experience with IVR in this population will help establish its longer-term efficacy.

Corneal tissue welding with infrared laser irradiation after clear corneal incision.

Purpose: The aim of this study was to investigate the potential of infrared lasers for corneal welding to seal corneal cuts done in an experimental animal model. Materials and Methods: Full-thickness corneal cuts on freshly enucleated bovine eyes were irradiated with infrared (809-nm diode, 980-nm diode, 1070-nm YLF, and 1980-nm Tm:YAP) lasers to get immediate laser welding. An 809-nm laser was used with the topical application of indocyanine green to enhance the photothermal interaction at the weld site. In total, 60 bovine eyes were used in this study; 40 eyes were used in the first part of the study for the determination of optimal welding parameters (15 eyes were excluded because of macroscopic carbonization, opacification, or corneal shrinkage; 2 eyes were used for control), and 20 eyes were used for further investigation of more promising lasers (YLF and Tm:YAP). Laser wavelength, irradiating power, exposure time, and spot size were the dose parameters, and optimal dose for immediate closure with minimal thermal damage was estimated through histological examination of welded samples. Results: In the first part of the study, results showed that none of the applications was satisfactory. Full-thickness success rates were 28% (2 of 7) for 809-nm and for 980-nm diode lasers and 67% (2 of 3) for 1070-nm YLF and (4 of 6) for 1980-nm Tm:YAP lasers. In the second part of the study, YLF and Tm:YAP lasers were investigated with bigger sample size. Results were not conclusive but promising again. Five corneal incisions were full-thickness welded out of 10 corneas with 1070-nm laser, and 4 corneal incisions were partially welded out of 10 corneas with 1980-nm laser in the second part of the study. Conclusions: Results showed that noteworthy corneal welding could be obtained with 1070-nm YLF laser and 1980-nm Tm:YAP laser wavelengths. Furthermore, in vitro and in vivo studies will shed light on the potential usage of corneal laser welding technique.

Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema.

PurposeThe aim of this study is to compare the therapeutic effect of a single intravitreal bevacizumab (IVB) injection in eyes with diabetic macular oedema (DMO) of different patterns determined by optical coherence tomography (OCT).MethodsMedical records of patients who had a single IVB injection for DMO were analysed retrospectively. Eyes with a clinically significant DMO and a central foveal thickness (CFT) of 250u2009μm or more determined by OCT were included in the analysis. Best-corrected visual acuity (BCVA), CFT and total macular volume values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular oedema (CMO) and serous retinal detachment (SRD) groups according to the morphology on OCT.ResultsA total of 92 eyes (42 with DRT, 31 with CMO and 19 with SRD) were included in the study. There was no statistically significant variation between three groups regarding the change in BCVA (P=0.695). CMO and SRD groups had greater reductions in their mean CFT, and the amount of reduction showed statistically significant variation between three groups (P=0.048). However, no statistically significant difference was found between groups in terms of percentage of change in CFT (P=0.278).ConclusionCMO and SRD subtypes are associated with a greater reduction in the CFT than the DRT subtype. Although the change in BCVA was not significantly different between groups, the DRT group showed markedly better visual improvement in proportion to the decrease in CFT.

Simultaneous Intravitreal and Intracameral Injection of Bevacizumab (Avastin) in Neovascular Glaucoma

PURPOSEnTo report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization.nnnPATIENTS AND METHODSnThe study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle.nnnRESULTSnAfter treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations.nnnCONCLUSIONSnSimultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.

Intravitreal bevacizumab injection in patients with choroidal neovascularization due to choroid rupture after blunt-head trauma

Purpose To describe and report the effect of intravitreal bevacizumab (Avastin) as primary treatment for secondary choroidal neovascularization (CNV) after choroidal rupture due to blunt-head trauma. Design Interventional case report. Methods The study was of the left eye of a patient who presented with choroidal neovascularization secondary to choroidal rupture due to blunt-head trauma. The patient received single intravitreal injection of 1.25xa0mg (0.05xa0ml) bevacizumab as treatment for CNV after informed consent was signed. The patient underwent fundus fluorescein angiography (FA) and optic coherence tomography (OCT) before the bevacizumab injection and then again three months after. Visual acuity was also measured before and after treatment. The patient was re-examined on the first day, and monthly thereafter. After intravitreal injection of bevacizumab the visual and anatomic responses were observed. Results The patient showed regression of the neovascularization three months after injection of bevacizumab. There was no loss of vision in the immediate postoperative period and at the 3rd month vision improved from 20/60 to 20/20. Central retinal thickness decreased. No cataract progression, endophthalmitis, or injection-related complications were observed. Conclusions Our study shows that intravitreal 1.25xa0mg bevacizumab can be an effective alternative treatment for choroidal neovascularization (CNV) due to choroidal rupture.

Short-term effects of intravitreal ranibizumab and bevacizumab administration on 24-h ambulatory blood pressure monitoring recordings in normotensive patients with age-related macular degeneration

PurposeTo evaluate effects of intravitreal ranibizumab and bevacizumab administration on ambulatory blood pressure monitoring (ABPM) recordings in normotensive patients with age-related macular degeneration (AMD).Patients and methodsA total of 72 patients (mean age: 61.8(6.2) years, 52.8% were females) diagnosed with AMD were included in this study as divided into ranibizumab (n=34) and bevacizumab (n=38) treatment groups. Twenty-four hour, nighttime, and daytime ABMP values for systolic and diastolic BP were recorded in study groups before and after the third intravitreal injection of ranibizumab or bevacizumab.ResultsRanibizumab injection had no impact on ABPM recordings and dipping status. In the bevacizumab group, increased daytime (129.0(6.6) vs 127.7(6.6) mmu2009Hg, P=0.002) and nighttime systolic (116.9(7.5) vs 112.6(7.1) mmHg, p<0.001) BP and decreased daytime diastolic (80.1(6.5) vs 82.4(6.1)mmu2009Hg, P=0.001) BP were noted in the post-injection period. Also, percentage of non-dippers was significantly increased from 5.3% at pre-injection to 28.9% (P=0.004) at the post-injection period.ConclusionIn conclusion, given that it has no significant impact on ABPM recordings and dipping status, in our study, intravitreal ranibizumab injection may be the better choice in the management of AMD.

Acute retinal arterial occlusion after intravenous administration of bevacizumab.

Retinal artery occlusions are usually the result of emboli, although non-embolic causes such as vasculitides, coagulopathies, and vasospasms resulting from migraines and inflammatory conditions do occur. Bevacizumab, a humanised monoclonal antibody, is designed to bind to and inhibit vascular endothelial growth factor (VEGF). VEGF is a protein that plays a critical role in tumour angiogenesis, the formation of new blood vessels to the tumour. The use of bevacizumab has spread worldwide, but the drug related adverse events associated with its use have been reported in a few retrospective reviews. We report on a previously unpublished case of retinal artery occlusion following the use of systemic bevacizumab.

Evaluation of the effect of combined intravitreal ranibizumab injection and sub-tenon steroid injection in the treatment of resistant diabetic macular edema

PurposeTo compare sub-tenon steroid plus anti-VEGF injection with anti-VEGF injection solely in the treatment of resistant diabetic macular edema (DME).MethodPatients who exhibited insufficient anatomic [over 350xa0μm central macular thickness (CMT)] and less than 3 lines of visual gain at least six anti-VEGF injections, were randomly divided into two groups. In group I, the anti-VEGF injection was performed 10xa0days after the sub-tenon steroid injection [Triamcinolone acetonide (Sinakort-A®)]. And anti-VEGF was performed when needed during the follow-up period. In group II, treatment was continued with anti-VEGF only. All patients’ visual acuity and CMT were followed up for 6xa0months.ResultsThe baseline BCVA in group I and group II was 0.51u2009±u20090.667 logMAR and 0.47u2009±u20090.60 logMAR, respectively (pu2009=u20090.52). In group I and II, at the end of 6-month follow-up, BCVA improved to 0.38u2009±u20090.60 logMAR (pu2009<u20090.001) and 0.43u2009±u20090.60 logMAR (pu2009=u20090.20), respectively. The baseline CMT in group I and group II was 494u2009±u2009118.32 and 438.20u2009±u200990.99xa0μm, respectively (pu2009=u20090.029). In group I and II, at the end of 6xa0months, CMT decreased to 302.57u2009±u200969.89xa0μm (pu2009<u20090.001) and 439.20u2009±u2009107.6xa0μm (pu2009=u20090.96), respectively.ConclusionAdding steroid to routine anti-VEGF treatment is an effective way of treatment method for resistant DME.

Evaluation of Biochemical Composition of Vitreous of Eyes of Diabetic Patients Using Proton Magnetic Resonance Spectroscopy

ABSTRACT Purpose: To investigate possible metabolic changes in vitreous of patients with diabetes mellitus with or without diabetic retinopathy using proton magnetic resonance spectroscopy. Material and methods: Twenty-eight healthy control subjects (group 1), 18 patients with diabetes mellitus without diabetic retinopathy (group 2) and 18 patients with diabetic retinopathy (group 3) were included. Proton magnetic resonance spectroscopy was performed in left vitreous of all subjects; amounts of Glutamate, Choline, Lactate and Creatine values were measured. Choline/Creatine, Glutamate/Creatine and Lactate/Creatine ratios were calculated. Results: Glutamate/Creatine and Lactate/Creatine ratios were significantly higher in group 2 and 3 when compared to group 1. Both Glutamate/Creatine and Lactate/Creatine ratios did not show any difference in group 2 when compared to group 3. Conclusions: Our results suggest that when compared to healthy subjects, Glutamate and Lactate are the main metabolites of vitreous in diabetes mellitus patients. This may help us to better understand the metabolic factors in pathogenesis of diabetic retinopathy.