The Effect of Intravitreal Injection of Bevacizumab on Retinal Circulation in Patients with Neovascular Macular Degeneration

Fontaine, Olivier; Olivier, Sébastien; Descovich, Denise; Cordahi, Ghassan; Vaucher, Elvire; Lesk, Mark R.

doi:10.1167/iovs.10-6646

Cited by 39 publications

(46 citation statements)

References 34 publications

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“…Our findings contrast findings from previous studies [10][11][12] looking at vasculature changes following anti-VEGF treatment in neovascular AMD, where a significant decrease in arteriolar diameter at 3 months and 1 year was seen. These studies, however, had significant limitations, given that only arteriolar calibre was assessed and the lack of a control group.…”

Section: Discussioncontrasting

confidence: 99%

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Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period

Wickremasinghe

Xie

Guymer

et al. 2012

Eye

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Purpose To assess retinal vascular calibre changes in eyes with neovascular age-related macular degeneration (AMD), treated with intravitreal anti-vascular endothelial growth factor agents, over a 1-year period and compare any such changes to untreated fellow eyes. Methods Treatment naïve patients with neovascular AMD received three consecutive intravitreal injections of ranibizumab, followed by a pro re nata dosing regimen up to 1 year, with the aim of maintaining a 'fluid-free' macula. Retinal arteriolar and venular calibre was measured from digital fundus photographs at baseline and at three monthly intervals to 1 year, and summarised as central retinal artery equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively. Results A total of 53 injected eyes and 41 fellow, non-injected eyes were analysed. At baseline, there were no differences in retinal vascular calibre between injected and non-injected eyes (mean CRAE (SD) 144.93 (14.07) vs 145.74 (13.10) lm, P ¼ 0.80 and mean CRVE (SD) 216.23 (25.93) vs 219.91 (22.82) lm, P ¼ 0.53). Over a 12-month period, retinal venular calibre dilatation occurred in injected eyes (mean CRVE change þ 5.71 (14.71) lm, P ¼ 0.007), with no change in retinal arterioles, þ 0.69 (14.71) lm, P ¼ 0.68. In noninjected eyes, arteriolar narrowing occurred as a whole, mean CRAE change À 4.20 (7.00) lm, P ¼ 0.001, over 12 months, with a trend for narrowing in venules, À 2.16 (11.56) lm, P ¼ 0.28. In injected eyes, after controlling for covariates, the changes in CRVE over 12 months mirrored improvements in macular thickness, À 0.06 ( À 0.005, À 0.11) lm, P ¼ 0.04, and visual acuity, þ 9.66 ( À 0.30, þ 19.32) lm, P ¼ 0.06. Conclusion Intravitreal ranibizumab significantly dilated retinal venules after a 1-year period.

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Section: Discussioncontrasting

confidence: 99%

“…11 A more recent study on 23 patients also found decreased retinal arteriolar diameter during the course of initial anti-VEGF injections for neovascular AMD. 12 No significant change in blood flow was observed. All these studies, however, were limited by a lack of a control group.…”

Section: Introductionmentioning

confidence: 89%

Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period

Wickremasinghe

Xie

Guymer

et al. 2012

Eye

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“…Using a bidirectional laser Doppler flowmeter, Fontaine et al [23] demonstrated that the baseline retinal arteriolar diameters decreased significantly after the first BEV injection and persisted until the fifth week after the third BEV dose. During the study period, the authors did not observe any alterations in retinal blood flow in 23 eyes of 23 patients.…”

Section: Discussionmentioning

confidence: 99%

“…There are even some reports on a fellow-eye treatment effect for intravitreal RAN and BEV [31,32] . None of the prior vessel diameter studies [19][20][21]23] , except 1 [22] , presented any results pertaining to noninjected fellow eyes following anti-VEGF delivery. Intravitreal RAN did not induce any alterations in vessel caliber in the noninjected eyes [22] .…”

Section: Discussionmentioning

confidence: 99%

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration

et al. 2017

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Purpose: The aim of this paper was to assess and compare the effects of intravitreal ranibizumab and bevacizumab on retinal vessel diameter in eyes with neovascular age-related macular degeneration (AMD). Methods: Patients with neovascular AMD who underwent intravitreal injection of either ranibizumab or bevacizumab were included. Noninjected fellow eyes served as a control. The main outcome measures were central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and the artery-vein ratio (AVR). Results: In the ranibizumab group, the mean CRAE value decreased significantly at 1 week and 1 month (p = 0.002). The AVR value decreased significantly at 1 month (p = 0.028). CRVE values did not change at 1 week and 1 month (p = 0.083). In the bevacizumab group, the preinjection CRAE, CRVE, and AVR values did not change through the study period (p = 0.128, p = 0.600, and p = 0.734, respectively). Conclusion: These results suggest that intravitreal ranibizumab led to significant retinal arteriolar vasoconstriction in eyes with neovascular AMD.

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“…The finding of a major increase of RBFV occurring in arterioles supports the theory of vasoconstriction being the major driver of increase in RBFV. 20,21 In this set of patients, we found only a weak association between changes in IOP and blood flow velocity (data not shown). We therefore conclude that changes in RBFV were not substantially affected by changes in IOP.…”

Section: Main Findingsmentioning

confidence: 64%

Blood flow velocity measured using the Retinal Function Imager predicts successful ranibizumab treatment in neovascular age-related macular degeneration: early prospective cohort study

Böhni

Howell

Bittner

et al. 2015

Eye

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Purpose Anti-VEGF treatment has a potent vasoconstrictive effect. Early changes of retinal blood flow velocity (RBFV) measured using the Retinal Function Imager (RFI) combined with indicators of vascular status may help in predicting the visual outcome 1 month post injection in patients with neovascular age-related macular degeneration (nvAMD) under ranibizumab treatment. To develop a simple prediction model based on the change in RBFV 3 days post injection and indicators of a patient's vascular status to assess the probability of a successful visual outcome 1 month post injection.Methods RBFV measured using RFI were prospectively collected pre-injection and 3 days post injection in 18 eyes of 15 patients. Indicators of vascular status (history of hypertension, diabetes mellitus without retinal affection, and smoking) were assessed by medical history. By univariate analyses, parameters associated with visual outcome were weighted (−1 to 6 points). A multivariate logistic regression model with the categorized visual outcome parameter (≥0 letters gained after 1 month) as the dependent variate and the sum score as the independent variate (continuous scale) was used to estimate the score value-specific probabilities of letters gained ≥ 0 1 month post injection. Results The indicators of vascular status negatively influenced the likelihood of a letter gain ≥ 0 whereas an increase in the arterial RBFV strongly increased it. The area under the receiver operating characteristics curve for these parameters investigated was 0.71 (95% CI: 0.43-1.00). Conclusion Changes in the arterial RBFV following 3 days after ranibizumab injection combined with three indicators of the vascular status identified nvAMD patients with favorable visual outcome accurately.

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The Effect of Intravitreal Injection of Bevacizumab on Retinal Circulation in Patients with Neovascular Macular Degeneration

Cited by 39 publications

References 34 publications

Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period

Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period

Comparative Retinal Vessel Size Study of Intravitreal Ranibizumab and Bevacizumab in Eyes with Neovascular Age-Related Macular Degeneration

Blood flow velocity measured using the Retinal Function Imager predicts successful ranibizumab treatment in neovascular age-related macular degeneration: early prospective cohort study

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