군날개 치료로서 술 전 베바시주맙 주입 후 시행한 자가결막이식술의 효과

김용일,이근영,김은주,김연희,이규원,박영정 대한안과학회 2015 대한안과학회지 Vol.56 No.6

목적: 군날개의 치료로서 자가결막이식술 전 베바시주맙(Bevacizumab)을 결막하 주사했을 때 그 효과를 알아보고자 한다. 대상과 방법: 군날개 환자 25명 25안에 Bevacizumab 2.5 mg (0.1 mL)을 결막하 주사 후 1-2주 뒤 자가결막이식술을 시행하였다.대조군도 동일한 수술을 하였다. 술 후 2주, 1개월, 이후 매달 시간에 따른 임상효과, 합병증을 알아보고 수술 시 채취한 군날개 조직으로 Bevacizumab의 효과를 평가하였다. 결과: 술 전 Bevacizumab을 주입한 군에서 대조군에 비해 세극등현미경검사상 충혈이 감소하였고 광학현미경검사상 조직의 혈관정도가 감소하였다. 면역조직화학검사상에서도 술 전 Bevacizumab을 주입한 군에서 대조군에 비해 혈관내피세포성장인자(vascular epithelial growth factor, VEGF)의 염색 정도가 낮게 나타났고 western blot 검사상 군날개 조직에서 VEGF의 발현도 의미 있게 낮았다(p<0.05). 경과관찰 중 두 군 모두 재발은 없었으나 술 후 자가결막이식편의 상처치유 반응은 술 전 Bevacizumab을 주입한 군에서 대조군에 비해 술 후 2개월째 이식편의 부종이 유의하게 오래 지속되었다(p<0.05). 결론: 술 전 Bevacizumab을 주입한 후 자가결막이식술 시행 시, 군날개의 혈관 정도와 VEGF 농도를 의미 있게 감소시켰으나 술후 자가결막 이식편의 부종이 오래 지속되었다. 이는 Bevacizumab이 혈관형성 억제뿐만 아니라 림프관의 형성도 함께 억제하는 기전으로 생각되어 군날개 치료로 수술 전 Bevacizumab을 적용 시에는 창상치유가 지연됨을 고려해야 할 것으로 생각된다. Purpose: To evaluate the effect of subconjunctival bevacizumab injection before conjunctival autograft for pterygium. Methods: Twenty-five eyes (25 patients) with pterygium received a subconjunctival injection of 2.5 mg (0.1 mL) bevacizumab 1-2 weeks prior to conjunctival autograft surgery. The control group (25 eyes of 25 patients) received the same operation. Two weeks, 1 month and every month after the surgery, the vascularization of surgical site, the recurrence rate and the effect of wound healing were analyzed. Results: The bevacizumab group showed a decreased conjunctival vascularity grade compared with the control group based on light microscopy. The bevacizumab group also showed lower vascular epithelial growth factor (VEGF) compared with the control group using immunohistochemical analysis and western blot. There was no recurrence in both groups, but, persistent autograft edema was observed at 8 weeks postoperatively in the bevacizumab group. Conclusions: Although preoperative injection of bevacizumab effectively reduced vascularity and VEGF concentration of pterygium tissue, prolonged autograft edema was observed. Based on these results, bevacizumab inhibits lymphangiogenesis as well as angiogenesis. Therefore, delayed wound healing should be considered when subconjunctival bevacizumab injection is administered before pterygium surgery.

Real-world efficacy and safety of bevacizumab single-maintenance therapy following platinum-paclitaxel chemotherapy plus bevacizumab in patients with advanced cervical cancer

Saki Kotaka,Eiji Kondo,Yosuke Kawai,Kota Okamoto,Yasuyuki Kishigami,Takaharu Yamawaki,Kenji Nagao,Toru Hirata,Shiro Suzuki 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.5

Objective: Bevacizumab maintenance therapy following platinum-based combination chemotherapy for metastatic, recurrent, or persistent cervical cancer is not recommended as standard therapy. This pilot study aimed to evaluate the efficacy and safety of bevacizumab maintenance therapy and the contribution of the platinum-free interval to the efficacy of subsequent chemotherapy for advanced cervical cancer. Methods: We retrospectively identified 115 patients with metastatic, recurrent, or persistent cervical cancer treated with platinum-paclitaxel chemotherapy plus bevacizumab at 7 institutions between 2015 and 2020. The primary endpoints were overall survival (OS) and progression-free survival (PFS) in patients who received bevacizumab maintenance therapy and those who did not. We also analyzed the adverse events associated with bevacizumab and survival time from the start of subsequent chemotherapy in both groups. Results: Following platinum-paclitaxel plus bevacizumab chemotherapy, 34 patients received bevacizumab maintenance therapy and 81 patients did not. Of the 115 patients, 56 received chemotherapy for subsequent relapse. Although bevacizumab maintenance therapy prolonged PFS (median of 16.0 months vs. 9.0 months, p=0.041), significant differences were not observed in OS (p=0.374). Furthermore, bevacizumab maintenance therapy did not prolong OS and PFS after the start of subsequent chemotherapy (p=0.663 and p=0.136, respectively). Bevacizumab maintenance therapy significantly increased hypertension (p=0.035) and proteinuria (p=0.005) but did not cause complications leading to death. Conclusion: Bevacizumab single-maintenance therapy for advanced cervical cancer can be considered in selected cases, such as those with acceptable bevacizumab-related side effects. The outcomes of our study will likely contribute to decision-making regarding practical treatment strategies.

당뇨황반부종에서 베바시주맙 단일주입과 저용량 베바시주맙-트리암시놀론 혼합주입 단기효과 비교

김병선,정인영,박종문,한용섭,Byoung Seon Kim,In Young Chung,Jong Moon Park,Yong Seop Han 대한안과학회 2014 대한안과학회지 Vol.55 No.8

Purpose: To report the effects and intraocular pressure results of intravitreal bevacizumab alone injection compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with diabetic macular edema. Methods: In total, 40 eyes of 40 patients diagnosed with diabetic macular edema were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness, and intraocular pressure of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. Results: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, BCVA increased significantly at 1 month, 2 months, and 3 months after injection (<em>p </em>< 0.05). In addition, in both groups, neither intraocular pressure (IOP) nor central macular thickness increased significantly at 1 month, 2 months, or 3 months after injection (<em>p</em> > 0.05). The BCVA, IOP, and central macular thickness (CMT) at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (<em>p</em> > 0.05). Conclusions: The BCVA of both groups increased significantly, and the CMT of both groups decreased significantly in patients with diabetic macular edema. The injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of diabetic macular edema. J Korean Ophthalmol Soc 2014;55(8):1155-1161

황반부종을 동반한 분지망막정맥폐쇄의 관류에 따른 덱사메타손삽입물과 베바시주맙의 비교

이승준,최창욱 한국망막학회 2020 Journal of Retina Vol.5 No.2

Purpose: To compare the difference of efficacy between intravitreal dexamethasone implant and bevacizumab injection for patients with branch retinal vein occlusion (BRVO) with macular edema (ME) according to macular perfusion status. Methods: This study comprised 104 eyes of 104 patients who were first diagnosed with BRVO with ME and were able to be observed for more than 6 months and retrospectively analyzed. Based on the results from fluorescein angiography, the patients were classified into either non-perfusion or perfusion type according to macular perfusion status, and treatment with either an intravitreal dexamethasone implant or bevacizumab injection was performed. If the patient experienced a relapse after the first bevacizumab injection, the treatment was replaced with dexamethasone implant, or retreatment was performed with bevacizumab. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) before treatment and at 6 months after treatment were analyzed in each treatment group. Results: In the non-perfusion type, all treatment methods resulted in significant changes in BCVA and CMT; in the perfusion type, there was a significant change in CMT. Post-hoc analysis regarding the changes in BCVA and CMT demonstrated a significant difference in the changes of BCVA and CMT between the dexamethasone implant group and the bevacizumab injection group in patients in the non-perfusion type (p = 0.028, p = 0.008, respectively), and there was a significant difference in change of BCVA between the group that replaced bevacizumab with dexamethasone implant and the group that reinjected bevacizumab (p = 0.005). Conclusions: Treatment with either intravitreal dexamethasone implant or bevacizumab injection was effective in patients with ME due to BRVO, regardless of macular perfusion status. Treatment with intravitreal dexamethasone implant in patients with non-perfusion type ME due to BRVO may have better functional and anatomical results than bevacizumab injection. 목적: 분지망막정맥폐쇄에 의한 황반부종 환자에서 황반부 관류 형태에 따른 유리체강내 덱사메타손삽입물과 베바시주맙주입술과 간의 치료 효과 차이를 알아보고자 한다. 대상과 방법: 황반부종이 동반된 분지망막정맥폐쇄를 진단받고 6개월 이상 경과 관찰이 가능하였던 환자 104명의 104안을 대상, 후향적으로 의무기록을 분석하였다. 황반부의 관류 형태에 따라 관류형과 비관류형으로 구분하여 덱사메타손삽입물 혹은 베바시주맙주입술을 시행하였고, 베바시주맙 치료 후 재발시 덱사메타손삽입물로 교체하거나 베바시주맙을 재치료하였다. 치료 전, 치료 6개월째의 최대교정시력과 중심황반두께의 변화를 각각의 치료군에서 분석하였다. 결과: 비관류형에서 치료 전후 모든 치료 방법에서 최대교정시력과 중심황반두께의 의미있는 변화를 보였으며, 관류형에서는 중심황반두께의 의미있는 변화를 보였다. 최대교정시력과 중심황반두께의 변화량에 대한 사후분석에서 비관류형의 덱사메타손삽입물과 베바시주맙주입술 두 군 간 최대교정시력과 중심황반두께 변화량은 유의한 차이가 있었고(각각 p = 0.028, p = 0.008), 베바시주맙에서 덱사메타손삽입물로 교체한 군과 베바시주맙을 주입한 군 간에서 최대교정시력 변화량이 유의한 차이를 보였다(p = 0.005). 결론: 분지망막정맥폐쇄에 의한 황반부종 환자에서 황반부 관류 형태에 상관없이 덱사메타손삽입물 또는 베바시주맙주입술 치료는 효과가 있었고, 특히 황반부 비관류가 있는 환자에서 덱사메타손삽입물 치료가 베바시주맙주입술에 비해 기능과 해부학적으로 좋은 결과를 보일 수 있다.

각막 신생혈관을 동반하는 외안부 질환에 대한 베바시주맙 테논낭하 주사의 효과

정재훈,전연숙,김재찬 대한안과학회 2009 대한안과학회지 Vol.50 No.10

Purpose: To investigate the effect of an injection of bevacizumab into the sub-Tenon’s capsule on ocular surface neovascularization disease including pterygium and corneal neovascularization. Methods: Twenty-five eyes of 21 patients with pterygium and 19 eyes of 15 patients with corneal neovascularization were given an injection of 5 mg bevacizumab into the sub-Tenon’s capsule. The clinical effects and complications were evaluated by analyzing the changes in anterior segment photo, visual acuity, and intraocular pressure at week one, week two, week four, and every month thereafter. Results: After injections of bevacizumab, partial remission of corneal neovascularized lesion was observed in five eyes (20%) of the pterygium group, and there were no significant changes in the visual acuity and no complications. In the corneal neovascularization group, corneal neovascularized lesions of 18 eyes (95%: 2 eyes, complete remission 16 eyes, partial remission) improved after injections of the bevacizumab and the scores of extent and severity of corneal neovascularized lesion improved significantly, unlike the pterygium group. The visual acuity of two eyes (11%) improved more than two lines of Yong-Han Jin’s distance visual acuity test and there were no systemic side effects. Localized side effects included four eyes (21%) with punctate epithelial erosions and two eyes (11%) with temporary, elevated intraocular pressure in the corneal neovascularization group. The side effects improved without any additional treatment. Conclusions: An injection of bevacizumab into the sub-Tenon’s capsule is more effective in fresh lesions of corneal neovascularization disease than in old and stable lesions of pterygium. Therefore, it could be used as a prominent treatment of various corneal neovascularization diseases. 목적: 군날개와 각막 신생혈관을 포함하는 외안부 신생혈관 질환에서 bevacizumab을 테논낭하로 주입한 효과를 확인하고자 하였다. 대상과 방법: 군날개 환자 25안과 각막 신생혈관 질환 환자 19안을 대상으로 병변 부위 테논낭하로 bevacizumab 5 mg를 주입한 후 1주, 2주, 1달 그리고 매달 전안부 사진 분석을 통해 임상효과와 부작용을 평가하였다. 결과: Bevacizumab 주입 후 군날개 환자군은 5안(20%)에서 신생 혈관 병변 부분관해가 있었고, 각막 신생혈관 환자군은 2안의 완전 관해와 16안의 부분관해를 포함하여 18안(95%)에서 병변이 호전되었으며, 사진 분석 결과 병변의 범위와 심한 정도의 점수도 유의하게 호전된 것으로 나타났다. 각막 신생혈관 환자군 2안에서 시력 향상이 관찰되었고, 4안의 점상각막상피미란과 2안의 일시적인 안압상승 등 국소적인 부작용이 관찰되었으나 특별한 치료 없이 호전되었다. 결론: Bevacizumab의 테논낭하 주사 치료는 신생혈관 병변이 오래되고 안정적인 군날개보다는 초기의 각막 신생혈관 질환에서 더 효과 적이므로 다양한 각막 신생혈관 질환에서 유용한 치료로 활용할 수 있을 것으로 생각된다.

전이성 대장암 환자에서 혈관신생억제제 Bevacizumab 치료로 인한 혈전색전증 위험

신보람,이효정,박윤희,김재연,곽혜선,송영천 한국병원약사회 2011 병원약사회지 Vol.28 No.3

Combination treatment with bevacizumab and 5-fluorouracil (5-FU) based chemotherapy improves overall survival and progression free survival of patients with metastatic colo-rectal cancer (mCRC). But, arterial thromboembolism (ATE) and venous thromboembolism (VTE) were associated with bevacizumab, VEGF inhibitor. This study was performed to determine the risk of ATE and VTE associated with the use of bevacizumab. Total of 410 patients with m CRC who were administered combination treatment with bevacizumab and chemotherapy versus chemotherapy alone from January 2007 to August 2010 in Asan Medical Center were enrolled. Data was collected retrospectively from electronic medical record (EMR). The risk of thromboembolism (TE) was assessed by simple incidence rates and hazard ratios (HRs). The association between potential risk factors and TE was investigated by Cox proportional hazards regression. Combination treatment with Bevacizumab and chemotherapy, compared with chemotherapy alone, increased incidence rate of TE (9.8% vs 3.7%, p=0.018), VTE (6.1% vs 2%, p=0.038) and ATE (4.4% vs 1.7%, p=0.109). Univariate and multivariate HR of Bevacizumab group were respectively 3.09 (p=0.009), 5.90 (p=0.016). In conclusion, The use of bevacizumab was significantly associated with the increased risk of developing TE in mCRC receiving this drug. Further studies are needed to investigate the prevention and management of TE associated with bevacizumab.

망막분지정맥폐쇄에 합병된 황반부종에서 유리체강내 베바시주맙 주입술이 삶의 질에 미치는 영향

김지욱 ( Jee Wook Kim ),최경식 ( Kyung Seek Choi ),이미리 ( Mi Ri Rhee ),이성진 ( Sung Jin Lee ) 한국안전학회(구 한국산업안전학회) 2003 International Journal of Safety Vol.2 No.1

목적: 망막분지정맥폐쇄로 인한 황반부종 환자에서 bevacizumab을 이용한 치료가 시력과 관련된 삶의 질에 미치는 효과를 알아보고자 하였다. 대상과 방법: 망막분지정맥폐쇄로 인한 황반부종으로 bevacizumab 안내주입술을 받은 32명을 대상으로 시술 전과 시술 3개월 후, 최대교정시력, 빛간섭단층촬영, 한국어판 미국 국립안연구센터 시각기능 설문지 25를 이용한 설문조사를 시행하여 그 변화를 관찰하였다. 결과: Bevacizumab 주입 후 3개월째 최대교정시력과 중심황반두께, 황반부용적은 치료 전과 비교하여 유의하게 호전되었다. 설문조사에서는 총점이 유의하게 증가하였으며, 세부항목별로는 전반적 시력, 근거리 시력, 원거리 시력, 사회적 기능, 정신 건강, 역할의 제한, 의존성, 주변부 시력은 유의하게 호전되었고, 전반적인 건강, 눈 통증, 운전과 색각 면에서는 유의한 차이를 보이지 않았다. 결론: 망막분지정맥폐쇄에 합병된 황반부종에서 bevacizumab 주입술은 황반부종을 감소시켜 시력뿐만 아니라 시력과 관련된 삶의질도 효과적으로 향상시켰다. 그러나 다른 세부항목에 비해 운전과 색각에 관련된 삶의 질은 상대적으로 회복 속도가 느린 것을 알수 있다. Purpose: To evaluate the impact of intravitreal bevacizumab injection on visual function and vision-related quality of life (VR-QOL) in patients with branch retinal vein occlusion (BRVO) using the Korean version of the National Eye Institute Visual Function Questionnaire 25 (K-NEI-VFQ-25). Methods: This study included 32 normal control subjects and 32 patients with BRVO. The Korean version of NEI-VFQ-25 was answered by the patients with BRVO before and 3 months after intravitreal bevacizumab injection, as well as by normal control subjects. Clinical data were collected, including central macular thickness (CMT), total macular volume (TMV) (using time-domain optical coherence tomography [OCT]), and best corrected visual acuity (BCVA). Results: Visual acuity, CMT, and TMV significantly improved 3 months after intravitreal bevacizumab injections. No bevacizumab-related systemic or ocular adverse effects following intravitreal drug injections were observed. Significant improvement in the VFQ-25 composite score was observed in patients with BRVO. Subscale scores, including general vision, near activities, distance activities, social functioning, mental health, role difficulties, dependency, and peripheral vision, improved after injection. However, subscale scores regarding general health, ocular pain, driving, and color vision did not improve significantly. Conclusions: Intravitreal bevacizumab injection appears to be an effective treatment for visual function, as well as VR-QOL in macular edema secondary to BRVO. However, improvement of driving function and color vision appears to require a longer recovery time than visual function. J Korean Ophthalmol Soc 2012;53(10):1465-1471

Risk of Serious Neutropenic Events in Cancer Patients Treated with Bevacizumab: A Meta-analysis

Zhou, Fan,Shao, Jiang-Hua,Wu, Lin-Quan,Yin, Xiang-Bao,Yu, Xin Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.4

Bevacizumab has been approved for use in combination with chemotherapy to treat many types of cancer but associated neutropenic events, including febrile neutropenia, have been reported. To estimate the incidence and relative risk of neutropenic events in cancer patients treated with bevacizumab combination therapy, we searched PubMed, EMBASE, and Web of Science literature databases, as well as abstracts presented at the American Society of Clinical Oncology conferences, to identify relevant studies published from January 1966 to December 2011. Studies that compared bevacizumab plus chemotherapy or biological therapy with chemotherapy or biological therapy alone, and that had adequate safety data profiles, were selected for analysis. Statistical analyses were conducted to calculate the summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) using fixed- or random-effects models. A total of 22 clinical trials involving 15,056 patients were included in the analysis. The summary incidences of high-grade neutropenia (HGN) and high-grade febrile neutropenia (HGFN) in patients receiving bevacizumab was 27.3% (95% CI: 26.4%-28.3%) and 3.91% (95% CI: 3.51%-4.37%), respectively. The risks of HGN (RR=1.10; 95% CI: 1.02-1.19; P=0.02) and HGFN (RR=1.31; 95% CI: 1.08-1.59; P=0.005) were significantly increased in bevacizumab-treated patients, compared to those who did not receive bevacizumab. The RR of bevacizumab-associated HGN, but not HGFN, varied significantly with tumor types (P=0.005). The increased risk of bevacizumab-associated neutropenic events was dose-dependent, as the RR was greater at a dose of 5 mg/kg/week than at 2.5 mg/kg/week. Our findings suggest that bevacizumab addition to cancer therapy significantly increases the risk of serious neutropenic events, and this risk may be dose-dependent.

유리체내 베바시주맙과 라니비주맙 주입술이 전신 순환에 미치는 영향

윤명헌(Myung Hun Yoon),김영준(Young Jun Kim),이소영(So Young Lee),이강원(Kang Won Lee),진희승(Hee Seung Chin) 대한안과학회 2016 대한안과학회지 Vol.57 No.3

목적: 유리체내 항혈관내피성장인자 주입술 전후로 항혈관내피성장인자와 혈관내피성장인자의 혈중 농도가 어떻게 변화하는지 알아보았다. 대상과 방법: 총 28명의 망막 질환 환자를 대상으로 하여 17명에게 bevacizumab 1.25 mg을, 11명에게 ranibizumab 0.5 mg을 유리체내로 주입하였다. 주입 직전과 주입 후 1일, 1주, 1달에 혈액 샘플을 채취하여 혈중 anti-vascular endothelial growth factor (anti-VEGF) 농도와 VEGF 농도를 enzyme-linked immunosorbent assay (ELISA) 방법으로 측정하였다. 결과: Bevacizumab 투여 전 anti-VEGF 농도는 91.0 ng/mL에서 1일, 1주, 1달 후 각각 153.6, 196.3, 140.3 ng/mL로 증가하였고(각각 p<0.05), VEGF 농도는 투여 전 93.9 pg/mL에서 1일, 1주, 1달 후 각각 40.1, 24.7, 33.5 pg/mL로 감소하였다(각각 p<0.05). Ranibizumab 투여 전 anti-VEGF 농도는 177.6 ng/mL에서 1일, 1주, 1달 후 각각 177.5, 160.7, 175.3 ng/mL로 유의한 변화가 없었고 (각각 p>0.05), VEGF 농도도 투여 전 80.9 pg/mL에서 1일, 1주, 1달 후 각각 96.7, 106.3, 106.1 pg/mL로 유의한 변화가 없었다(각각 p>0.05). 결론: Ranibizumab과 달리 bevacizumab은 유리체내 주입술 후 혈중 VEGF 농도를 유의하게 낮췄다. 따라서 유리체내 bevacizumab 주입술의 전신적인 영향에 대한 고려가 필요할 수 있다. Purpose: The purpose of this study was to evaluate the systemic effects of ranibizumab and bevacizumab by examining the plasma levels of anti-vascular endothelial growth factor (anti-VEGF) and VEGF before and after a single intravitreal injection. Methods: Twenty-eight eyes of 28 patients with various retinal diseases were enrolled. Seventeen eyes received an injection of intravitreal bevacizumab, and 11 eyes received an injection of ranibizumab. Blood samples were collected just before and 1 day, 1 week, and 1 month after injection. Concentrations of anti-VEGF and VEGF in plasma were measured using enzyme-linked immunosorbent assay (ELISA). Results: In the bevacizumab group, anti-VEGF concentration before the injection was 91.0 ng/mL, while those at 1 day, 1 week, and 1 month post-injection increased to 153.6, 196.3, and 140.3 ng/mL, respectively (p < 0.05 for all). VEGF concentration before the injection was 93.9 pg/mL, while those 1 day, 1 week, and 1 month post-injection were reduced to 40.1, 24.7, and 33.5 pg/mL, respectively (p < 0.05 for all). However, in the ranibizumab group, no significant reductions in anti-VEGF concentration were observed. The anti-VEGF concentration before the injection was 177.6 ng/mL, while those at 1 day, 1 week, and 1 month post-injection were 177.5, 160.7, 175.3 ng/mL, respectively (p > 0.05 for all). VEGF level also showed no significant change. VEGF concentration before the injection was 80.9 pg/mL, while those at 1 day, 1 week and 1 month post-injection were 96.7, 106.3, 106.1 pg/mL, respectively (p > 0.05 for all). Conclusions: Contrary to ranibizumab, intravitreal bevacizumab significantly lowers plasma VEGF level in patients with various retinal diseases. The study suggests the consideration of the systemic effects of intravitreal bevacizumab injection.

Anti-Vascular Endothelial Growth Factor Treatment of Retinopathy of Prematurity: Efficacy, Safety, and Anatomical Outcomes

Hyun Goo Kang,Eun Young Choi,Suk Ho Byeon,Sung Soo Kim,Hyoung Jun Koh,Sung Chul Lee,Min Kim 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.6

Purpose: To investigate the efficacy, safety, and anatomical outcomes associated with intravitreal anti-vascular endothelial growth factor (VEGF) treatment of retinopathy of prematurity (ROP). Methods: We performed a retrospective review of intravitreal anti-VEGF (bevacizumab or ranibizumab) treatment of 153 eyes (83 infants) diagnosed with ROP at two tertiary hospitals from June 2011 to January 2017. The primary outcome was the rate of recurrence requiring additional treatment; secondary outcomes included incidence of major complications and final refractive error. Results: A total of 101 eyes were treated with bevacizumab, and 52 with ranibizumab. The bevacizumab and ranibizumab groups were characterized by mean birthweights of 941.8 ± 296.1 and 1,257.7 ± 514.5 g, gestational ages at birth of 26.9 ± 1.9 and 28.1 ± 3.2 weeks, and postmenstrual ages at treatment of 40.4 ± 2.4 and 39.2 ± 2.3 weeks, respectively. The two groups differed significantly in birthweights and gestational ages at birth, but not in postmenstrual ages at treatment. The mean follow-up duration was 30.9 ± 18.4 months for the bevacizumab group, and 13.9 ± 12.5 months for ranibizumab. More cases were classified as zone 1 ROP in the ranibizumab group (44.2% vs. 11.9%, p < 0.001). Major surgical interventions included scleral encircling and vitrectomy (one and two eyes, respectively, both in the bevacizumab group). Retinal detachment was noted in one eye treated with bevacizumab. There was no significant difference in the most recent spherical equivalence for the two groups (+0.10 ± 3.66 and +0.22 ± 3.00 diopters for bevacizumab and ranibizumab, respectively). Univariable analysis revealed that only ROP stage influenced the occurrence of major complications (odds ratio, 9.046; p = 0.012). Conclusions: Intravitreal anti-VEGF treatment of ROP with both bevacizumab and ranibizumab achieved stable retinal vascularization with a low rate of complications and recurrence. Ranibizumab achieved similar anatomical outcomes as bevacizumab, without additional risk for major complications.