Intravitreal Bevacizumab for Diabetic Macular Edema Associated With Severe Capillary Loss: One-Year Results of a Pilot Study

Purpose: To evaluate the effects of intravitreal bevacizumab in patients with diabetic macular edema (DME) associated with severe capillary loss. Design: Multicenter, open-label, nonrandomized study. Methods: setting: Two tertiary ophthalmic referral centers in Brazil. study population: Ten consecutive patients with DME and "severe" capillary loss. observation procedures: Intravitreal injection(s) of bevacizumab (1.5 mg). Standardized ophthalmic evaluation was performed at baseline and at weeks 8, 16, 24, and 54. main outcome measures: Changes in best-corrected visual acuity (BCVA) and in optical coherence tomography variables (central macular thickness [CMT] and total macular volume [TMV]). Results: Significant changes in BCVA and in CMT/TMV were noted throughout the study (P < .001, P = .009, and P < .001, respectively). The mean logarithm of the minimal angle of resolution Early Treatment Diabetic Retinopathy Study BCVA was 0.786 (∼20/125⁺¹) at baseline, 0.646 (∼20/80^-2) at week 8, 0.580 (20/80⁺¹) at week 16, 0.574 (∼20/80⁺¹) at week 24, and 0.558 (∼20/80⁺²) at week 54. Compared with baseline, a significant change in BCVA was noted at all follow-up visits (P ≤ .008). The mean CMT/TMV values were, respectively, 472.6/10.9 at baseline, 371.4/9.9 at week 8, 359.5/9.8 at week 16, 323.9/9.4 at week 24, and 274.6/8.7 at week 54. Compared with baseline, a significant change in both CMT and TMV was noted only at 24 and 54 weeks (P ≤ .007). At 54 weeks, fluorescein angiography demonstrated no change in the extent of macular capillary loss and reduced dye leakage as compared with baseline in all patients. Conclusions: Favorable changes in BCVA and in CMT/TMV observed throughout 1 year suggest that intravitreal bevacizumab may be a viable alternative treatment for the management of patients with DME and severe capillary loss.