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Anti-VEGF agent may be an option for nonresponsive CME
Intravitreal injection of bevacizumab safely, effectively treats post-surgical cystoid macular edema in patients who fail steroid and nonsteroidal therapy.
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 Yoshihide Nakai |
Patients who are nonresponsive to previous treatment for cystoid macular edema after cataract surgery may benefit from intravitreal bevacizumab.
The injection locally limits the production of VEGF and restricts vasopermeability in the blood retinal barrier caused by surgically induced inflammation, according to Yoshihide Nakai, MD, of the Tokai Eye Clinic in Tsu, Japan.
“Bevacizumab restrained this vasopermeability and led to resolution of cystoid macular edema,” Dr. Nakai told Ocular Surgery News in an e-mail interview.
Cystoid macular edema (CME) is frequent after cataract surgery and IOL implantation, occurring in up to 70% of cases. Most cases resolve without intervention, but about 2% will experience some loss of visual acuity. According to Dr. Nakai, if left untreated, CME may lead to permanent visual impairment.
Several steroid and nonsteroidal options exist for managing postsurgical CME, but efficacy may vary, and steroid options in particular raise safety questions. Intravitreal bevacizumab (Avastin, Genentech) may offer an alternative choice for cases with previous treatment failure, he said.
Dr. Nakai originally presented his data at the meeting of the American Society of Cataract and Refractive Surgery in San Francisco, U.S.A.
Study results
Intravitreal bevacizumab was injected in 12 patients with CME secondary to cataract surgery who did not respond to earlier therapy with steroid agents and NSAIDs. For the study, nonresponsiveness to prior treatment was defined as persistent CME for 1 month after the initial intervention. A 1.25-mg intravitreal injection was offered to patients with a macular thickness more than 350 µm and best corrected visual acuity less than 20/30.
Mean BCVA improved from 20/60 before injection to a mean 20/30 at 1 week, 20/25 at 1 month and 20/20 at 3 months after injection. Mean thickness of the macula also improved, from 765 µm before bevacizumab injection to 590 µm at 1 week, 371 µm at 1 month and 225 µm at 3 months after injection.
In all 12 patients, BCVA did not improve after their prior therapy, but did improve within 1 week of therapy with bevacizumab. According to Dr. Nakai, this supports the conclusion that anti-VEGF therapy was indeed the causative factor in CME resolution.
“It was judged that CME was improved by vitreous injection of bevacizumab, and that these were not spontaneous recoveries,” he said.
Therapy was well-tolerated, and there were no reports of adverse effects related to intravitreal bevacizumab injection.
“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,” Dr. Nakai said. – by Bryan Bechtel
- Yoshihide Nakai, MD, can be reached at Tokai Eye Clinic, 399 Hadokoro-cho, Tsu, Mie 514-0009 Japan; +059-225-3898; fax: +059-228-8111; e-mail: tokaieye@mint.or.jp. Dr. Nakai has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.