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PartⅠPURPOSE:To evaluate combination intravitreal Avastin(Bevacizumab) and modified macular grid photocoagulation for the treatment of Diabetic Macular Edema(DME) compared with intravitreal Avastin alone.METHODS:One hundred-two eyes of 73 patients with DME were randomized into 2 groups The laser group eyes(n=52) were subjected to a modified macular grid photocoagulation 3 weeks after intravitreal Avastin.The control group eyes(n=50) underwent only intravitreal Avastin.Both groups were compared with regard to the change in BCVA,NCT,and CRT in duration of follow up.RESULTS:Mean follow-up time 12.27±1.90months.At the 2-week,3-week,1-month, 3-month,6-month after intravitreal Avastin,mean BCVA(Log MAR) improved to 0.79±3.39,0.57±0.26,0.63±0.28,0.68±0.35,0.69±0.33 in the laser group,respectively,and in the control group,mean BCVA(Log MAR) improved to 0.82±0.41,0.54±0.31,0.58±0.31,0.64±0.32,0.80±0.33,respectively.The BCVA were not significantly different between the 2 groups(P1=0.69,P2=0.65,P3=0.34,P4=0.52,P5=0.089);At the 12-month after intravitreal Avastin,mean BCVA improved to 0.68±0.32 and 0.84±0.38 in the laser group and the control group,respectively.It was significantly different between the 2 groups (P=0.006).At the 2-week,3-week,1-month,3-month after intravitreal Avastin,mean CRT reduced to 269.12±90.96μm,210.62±45.49μm,221.85±45.59μm,228.52±52.91μm in the laser group,respectively,and in the control group,mean CRT reduced to 254.16±67.92μm,199.06±21.93μm,217.30±24.65μm,224.88±32.02μm,respectively.The CRTs were not significantly different between the 2 groups(P1=0.351,P2=0.108,P3=0.542,P4=0.677); At the 6-month,12-month after intravitreal Avastin,mean CRT reduced to 233.21±52.15μm,226.71±47.68μm in the laser group,respectively,and in the control group,mean CRT reduced to 255.32±45.61μm,267.48±53.24μm,respectively.There were significantly different between the 2 groups(P1=0.025,P2=0.000).The mean injection times were 2.85 in the laser group,and 3.50 in the control group, there were significantly different between 2 groups(P=0.016).No ocular or systemic adverse reactions were noted.CONCLUSION:Modified macular grid photocoagulation after intravitreal injection of Avastin effectively maintains improved visual acuity and CRT for DME and is believed to reduce the repeat injection time. PartⅡPURPOSE:To evaluate the effect of intravitreal Avastin(Bevacizumab) injection and retinal photocoagulation in patients with refractory macula edema secondary retinal vein occlusion. METHODS:Thirty-six eyes of thirty-six patients received combination with intravitreal injections(1.5 mg/0.06ml) of Avastin and retinal photocoagulation.Main outcome measures were best-corrected visual acuity(BCVA),slit lamp biomicroscopy,fundus photography,optical coherence tomography(OCT),intraocular pressure(IOP) measurements and fluorescein angiography in a 6～12months follow-up period.RESULTS:At the 1-month,3-month,6-month,12-month and last follow-up,mean BCVA(Log MAR) improved from 0.99±0.45 at baseline to 0.49±0.36(P=0.000),0.59±0.35(P=0.000),0.46±0.31(P=0.000),0.44±0.32(P=0.000),0.46±0.34(P=0.000),respectively.At the 1-month,3-month,6-month,12-month and last follow up, mean central retinal thickness decreased from 724.94±298.21μm at baseline to 230.75±71.01μm(P=0.000),248.86±105.18μm(P=0.000),206.75±60.96μm(P=0.000),199.03±33.00μm(P=0.000),202.53±53.24μm(P=0.000),respectively.At 3-month follow up (n=36),9 eyes displayed leakage arrest,19 eyes displayed leakage decrease,8 eyes unchanged in FFA.At 12-month follow up(n=29),17 eyes exhibited leakage arrest,8 eyes exhibited leakage to reduce,4 eyes unchanged.It is negative correlation between BCVA and CRT.No ocular or systemic adverse reactions were noted.CONCLUSION:Intravitreal injection of Avastin appears to be a effect treatment option for patients with retinal vein occlusion.Regularly OCT measurement may guide repeating treatment.PartⅢPURPOSE:To assess the effectiveness of intravitreal Avastin(Bevacizumab) for the treatment of idiopathic choroidal neovascularization.METHODS:20 eyes of 20 patients who underwent intravitreal Avastin injection for idiopathic choroidal neovascularization were reviewed.All eyes received intravitreal injections of Avastin 1.5 mg/0.06 ml and would be repeat injection if recurrence.The therapeutic effect was accessed by central retinal thickness(CRT) with optical coherence tomography(OCT),the best-corrected visual acuity,IOP,FFA,ICG.RESULTS:At the fist day,2-week,1-month,2-month,3-month,6-month,12-month after intravitreal Avastin,the best-corrected visual acuity from 0.71±0.55 at baseline to 0.61± 0.52(P=0.058),,0.42±0.42(P=0.000),0.28±0.40(P=0.000),0.16±0.30(P=0.000), 0.18±0.32(P=0.000),0.13±0.25(P=0.000),0.08±0.25(P=0.000),respectively.At the same-day,the central macular thickness from 271.55±148.68μm at baseline to 281.75±142.29μm(P=0.628),213.30±63.89μm(P=0.024),189.10±57.38μm(P=0.005)、187.35±60.61μm(P=0.015)、188.80±65.11μm(P=0.016)、177.60±53.88μm (P=0.005)、163.56±25.50μm(P=0.004),respectively.At 12-month of follow up,all eyes were significantly improved the BCVA and CRT.It is correlation between BCVA and the size of focus(r=0.618,P=0.006) and curing in 16 eyes(89%),take a favorable turn in 2 eyes(10%).No ocular or systemic adverse reactions were noted.CONCLUSION:intravitreal Avastin is a potential treatment for idiopathic choroidal neovascularization,can rapidly improve VA and decrease course of disease.PartⅣPurpose To evaluate the efficacy and safety of the surgical outcome of a trabeculectomy with mitomycin C(MMC) in neovascular glaucoma(NVG) after an adjunctive treatment with intravitreal Avastin(Bevacizumab).Methods 22 eyes of NVG with angle closure were treated with a intravitreal injection of 1.5 mg Avastin,then were performed trabeculectomy with MMC.The therapeutic effect was accessed by IOP,BCVA,the shape of filtration bubble.Result Average follow-up was 12.91±3.82 months.The mean regression time of iris neovascular(NVI) was 4.14±1.78 days.Trabeculectomy with MMC was performed in these 22 eyes at 1 week after of intravitreal injection of Avastin.At the last time of follow-up after surgery of these 22 eyes:intraocular pressure(IOP) was less than 21mmHg in 19 eyes(86.36%) and 3 eyes(13.64%) with anti-glaucoma drugs or with ciliary body photo-coagulation.Visual acuity improved more than 1 line in 14 eyes and no changed in 8 eyes.Ⅰtype filtration bubble was 27.27%,Ⅱtype filtration bubble was 59.09%,Ⅳtype filtration bubble was 13.64%.No serious complications were observed.Conclusion Intravitreal injection of Avastin could quickly induce regression of NVI, effectively avoid hemorrhage during trabeculectomy with MMC,relieve postoperation inflammation,elevate achievement ratio of the operation and preserve remained visual function.Nevertheless attention should be paid on the treatment of the protopathy at the same time.
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