Abstrakt

Bevacizumab (Avastin) in Treatment of Maculopathy secondary to Proliferative Diabetic Retinopathy (PDR) in Afghanistan

Mohammad Delsoz, P. Hollands

Objective: To investigate the efficacy of intravitreal anti-VEGF therapy in the treatment of maculopathy secondary to Proliferative Diabetic Retinopathy (PDR) in Afghanistan.

Methods: A retrospective analysis was conducted of all PDR cases that underwent intravitreal anti- VEGF injection at the four leading hospitals in Kabul. The main outcome measures were visual acuity, and central retinal thickness as determined by optical coherence tomography. Information was also collected on the distance travelled by each patient and frequency of injections.

Results: This is a clinical study which assessed the safety and efficacy of Bevacizumab (Avastin), manufactured by Genentech, in the treatment of maculopathy secondary to Proliferative Diabetic Retinopathy (PDR). All of the patients suffered from Type II Diabetes Mellitus.

A total of 174 (97 male, 77 female) patients (308 study eyes in total) took part in the clinical study with an average age of 57 years (range 27-80 years). 56 patients (32%) in the study were insulin dependent diabetics. Bevacizumab was given to patients by monthly intra-vitreal injections at a dose of 50 µL per treatment. The Visual Acuity (VA) was assessed using the Snellen technique before and after the Bevacizumab injection and with Optical Coherence Tomography (OCT).

The VA of patients who received Bevacizumab treatment showed an overall improvement. No significant ocular or systemic severe adverse events were observed. Mean central retinal thickness reduced from 328.6 µm ± 15.2 µm at baseline to 266.4 µm ± 11.3 µm following resolution after treatment (p<0.001). OCT showed improvements in all patients.

The mean baseline (pre-treatment) VA was log MAR=0.80 (Snellen=6/38). The mean 12 month followed up VA was log MAR=0.7 (Snellen=6/24).

In total 232 (75.3%) of the eyes remained stable in terms of VA and 46 (14.9%) of eyes showed in improvement in VA and 30 (9.8%) of the eyes had reduced VA.

Despite the challenges of healthcare provision in Afghanistan, this review shows that the use of intravitreal bevacizumab has provided an effective treatment for maculopathy secondary to PDR.