1. J. Fernando Arevalo, MD FACS Clínica Oftalmológica Centro Caracas
Intravitreal Bevacizumab (AvastinTM) for the Management of Refractory Pseudophakic CME: 12-months Follow-Up
J. Fernando Arevalo, MD FACS
Clínica Oftalmológica Centro Caracas
Caracas, Venezuela

2. Bevacizumab & Refractory Pseudophakic CME Co-authors
Mauricio Maia, MD
Rafael A. Garcia-Amaris, MD
Juan G. Sanchez, MD
Jose A. Roca, MD
Maria H. Berrocal, MD
Lihteh Wu, MD

3. The authors acknowledge no financial interest This presentation includes the off-label use of Bevacizumab (AvastinTM)

4. Bevacizumab & Refractory Pseudophakic CME Introduction
Incidence:
Angiographic CME: up to 20%
Clinically significant CME: 0%-13%
In most patients, CME resolves spontaneously, with 50% to 75% of patients achieving improved vision within 6 months
Some patients suffering permanent visual morbidity

5. Bevacizumab & Refractory Pseudophakic CME Introduction
Studies have demonstrated the usefulness of ITV bevacizumab:
CNV secondary to AMD
Macular edema secondary to CRVO
Pseudophakic CME
DME
INV, NVG & RN secondary to PDR B C

6. Bevacizumab & Refractory Pseudophakic CME Objective
To determine the 12-months feasibility, safety and clinical effect of IVT bevacizumab in patients with refractory CME after cataract surgery

7. Bevacizumab & Refractory Pseudophakic CME Methods
Interventional retrospective multicenter study of eyes with refractory pseudophakic CME treated with off-label IVT bevacizumab (AvastinTM)
36 eyes of 31 consecutive patients with a minimum follow-up of six months
Mean follow-up of 54.3 weeks (range: 24 to 90 weeks)
Mean age was 69.5 years (range: 50-87)
64.5% were female

8. Table 1: Patients’ Demographics
Intravitreal Bevacizumab
For Refractory Pseudophakic CME
No. of eyes/No. of patients
36/31
Age (years)
Mean
Range
69.5
50-87
Gender
Female
Male
20 (64.5%)
11 (35.5%)
Time Interval from CME symptoms to IVT injection (months)
16.2
3-120
Follow-up (weeks)
54.3
24-90

9. Bevacizumab & Refractory Pseudophakic CME Methods
21 cases (58.3%) were treated with a dose of 1.25 mg
15 cases (41.7%) were treated with a dose of 2.5 mg

10. Bevacizumab & Refractory Pseudophakic CME BCVA Results
The mean baseline BCVA was logMAR = 0.92 (20/160; range: )
The mean final BCVA was logMAR = 0.55 (20/63;range: )
p <

11. Table 2: BCVA Results Final BCVA Analysis by Sub-groups At 6 months
# Eyes
Percentage
Improved ≥ 2 ETDRS lines of BCVA 25
69.4%
Remained stable 11
20.6%
Decreased ≥ 2 ETDRS lines of BCVA 0%

12. Bevacizumab & Refractory Pseudophakic CME OCT Results
The baseline mean central macular thickness was µm (range: )
The final central macular thickness was µm (range: )
p <

13. Bevacizumab & Refractory Pseudophakic CME Reinjections
5 (13.9%) eyes needed a second injection at a mean of 17.4 weeks (range: 6-26)
9 (25%) eyes needed a third injection at a mean of 18.6 weeks (range: 7-45)
5 (13.9%) eyes needed a fourth injection at a mean of 17.5 weeks (range: 11-24)
1 (25%) eye needed a fifth injection at a mean of 14.5 weeks (range: 12-18)
The mean interval between injections was 17.6 weeks (range: 6-45 weeks)

14. Case 1. 2.5 mg Intravitreal Bevacizumab and Refractory Pseudophakic CME
A 64-year-old man with refractory pseudophakic CME presented with a VA of 20/160 in his right eye

15. Before Bevacizumab
VA 20/160
1 month later VA 20/63
6 months later VA 20/40
12 months later VA 20/32

16. Bevacizumab & Refractory Pseudophakic CME Conclusions
Bevacizumab modifies the natural history of macular edema by stabilizing the BRB in a rapid and effective form, facilitating fluid reabsorption in the retina and achieving a striking regression of CME with a remarkable decrease of foveal thickness
Therefore, complications of chronic CME (serous macular detachment, RPE changes, epiretinal membrane formation, and non-reversible macular changes with permanent visual loss) can be reduced or avoided

17. Bevacizumab & Refractory Pseudophakic CME Conclusions
In the future, this new treatment modality could be established as an alternative treatment for refractory CME after cataract surgery with a rapid reduction in macular edema and improvement in VA with no significant short-term complications
Furthermore, bevacizumab may be the only option in patients who are known steroid responders and who are unresponsive to NSAIDs