Optic Atrophy after Anti-vascular Endothelial Growth
Factor Injection in Diabetic Patients with Proliferative
Diabetic Retinopathy
Apichart Singalavanija MD*, Kornwipa Hemarat MD*,
Napang Kedkovid MD*, Jutalai Tanterdtham MD*, Chakrapong Namatra MD*,
Adisak Trinavarat MD*, Nattawut Rodanant MD*, Somanus Thoongsuwan MD*
Affiliation :
* Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To study the prevalence of optic atrophy in patients with proliferative diabetic retinopathy (PDR) who underwent
intravitreal bevacizumab injection and risk factors associated with optic atrophy.
Material and Method: A retrospective case control study enrolled 269 cases (394 eyes) of patients with PDR, in which
166 cases (219 eyes) received intravitreal bevacizumab injection. Associated factors such as type of DM, hemoglobin A1c
level, hypertension, hypercholesterolemia, chronic kidney disease, previous intravitreal surgery, retinal detachment, and
vitreous hemorrhage were recorded. Criteria for diagnosis of optic atrophy were decreased visual acuity, pale optic disc
and decreased nerve fiber layer thickness, which was measured by Stratus optical coherence tomography (OCT). The
association between intravitreal bevacizumab injection and optic atrophy was analyzed by multiple logistic regression.
Results : Two hundred sixty nine patients with PDR, consisting of 166 patients with intravitreal bevacizumab injection and
103 cases without bevacizumab injection. Optic atrophy was found in 11.4% (25/219 eyes) and 8% (14/175 eyes) respectively.
There was no evidence that intravitreal bevacizumab injection and associated systemic diseases were related to optic atrophy.
The risk factor that was related to optic atrophy was previous intravitreal surgery (adjusted odds ratio (OR), 2.57 [95% CI,
1.13, 5.84], p = 0.024).
Conclusion : Anti-VEGF (bevacizumab) does not increase the risk of optic atrophy. The ophthalmologists should be aware
of subsequent optic atrophy development in patients with PDR who undergo surgical intervention.
Keywords : Optic atrophy, Anti-vascular endothelial growth factor, Proliferative diabetic retinopathy
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