Outcomes of three intravitreal injections of bevacizumab given monthly for diabetic macular oedema is a viable treatment for an economically disadvantaged population

Abstract

Background: The treatment of diabetic macular oedema (DMO) by intravitreal injection (IVI) of approved anti-vascular endothelial growth factor (VEGF) is costly and hence off label use of bevacizumab is practiced in spite of concerns about its safety. Aim: To examine the effect of three IVI of bevacizumab given monthly, on best corrected visual acuity (BCVA) and central foveal thickness (CFT) of eyes with DMO. Setting: Charity hospital attached to a medical college in India. Methods: Patients with centre involving DMO with BCVA ≤ 6/9 and CFT ≥ 260 microns were recruited prospectively, and three IVI bevacizumab given monthly (from a common vial). At four months BCVA and CFT were assessed and compared with baseline data. Side effects, if any, were recorded. Best corrected visual acuity was converted to logMAR units for statistical analysis. Student’s t-test were conducted to see statistically significant changes in BCVA and CFT. Results: A total of 50 eyes of 38 patients received three monthly IVI bevacizumab. Best corrected visual acuity (logMAR) improved from baseline mean of 0.80 ± 0.49 to final mean of 0.51 ± 0.36, which was significant (p= 0.0001). The mean baseline CFT (μ m) improved from 448.40 ± 149.47 to 368.76 ± 131.49, which was significant (p= 0.0001). No cases of endophthalmitis were reported. Various factors such as diabetes duration and HbA1c (hemoglobinA1c) value were not found to be significant for the improvement in BCVA and CFT. Conclusion: Intravitreal injection bevacizumab given as three monthly injections was safe, economical and effective in the management of DMO.