Bernard Albert Rajkumar, S (2009) The role of intravitreal bevacizumab in the management of various retinal vascular diseases. Masters thesis, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli.
|
Text
2203041bernardalbertrajkumars.pdf Download (8MB) | Preview |
Abstract
INTRODUCTION: ANGIOGENESIS Angiogenesis is a physiological process involving the growth of new blood vessels from pre existing vessels. Though there has been some debate over this, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for new blood vessel formation by splitting off existing ones. Types Sprouting angiogenesis Sprouting angiogenesis was the first identified form of angiogenesis. It occurs in several well characterized stages. First, biological signals known as angiogenic growth factors activate receptors present on endothelial cells present in preexisting veins. Second, the activated endothelial cells begin to release enzymes called proteases that degrade the basement membrane in order to allow endothelial cells to escape trom the original (parent) vessel walls. The endothelial cells then proliferate into the surrounding matrix and form solid sprouts connecting neighboring vessels. As sprouts extend toward the source of the angiogenic stimulus, endothelial cells migrate in tandem, using adhesion molecules, the equivalent of cellular grappling hooks, called integrins. These sprouts then form loops to become a full-fledged vessel lumen as cells migrate to the site of angiogenesis. Sprouting occurs at a rate of several millimeters per day, and enables new vessels to grow across gaps in the vasculature. It is markedly different from splitting angiogenesis, however, because it forms entirely new vessels as opposed to splitting existing vessels. AIM OF THE STUDY: To evaluate the safety and efficacy of intravitreal Bevacizumab in the management of various retinal vascular diseases. PATIENTS AND METHODS: This prospective, interventional study was done at Retina Clinic, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli from June 2007 to July 2008. Inclusion Criteria 1 Patients with Proliferative Diabetic Retinopathy 2 Patients with retinal vein occlusion and neovascularization 3 Patients with wet Age related Macular Degeneration Exclusion Criteria 1. Presence of other retinal pathaology affecting Visual Acuity 2. Presence of Significant cataract Complete medical and ocular history was taken in the baseline visit. All patients underwent a complete ophthalmic examinations which include: 1 Best corrected distant and near vision 2 Intraocular pressure 3 Slit lamp examination 4 Fundus examination 5 Fundus photography 6 Fundus Fluorescein Angiography 7 Macular thickness with OCT SUMMARY: The Study entitled “The role of Intravitreal Bevacizumab in the Management of Various Retinal Vascular Diseases” was conducted at Retina Clinic, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli. A total of 50 eyes of 50 patients were studied. Baseline ophthalmic examination included: _ Best corrected visual acuity _ IOP measurement _ Slit lamp examination _ Fundus examination (+90 D lens & Indirect Ophthalmoscopy) _ Fundus photography _ Macular thickness with OCT _ Fundus Fluorescein Angiography Follow up was done at 3 days, 2 weeks, 1 month and then at monthly interval for six months. Observations _ Maximum number of patients belongs to the age group of 51 – 60 years. _ Out of 50 respondents 29 were female and 21were male. _ 50 patients have received injection in one of the eyes. _ 33 cases had diabetic retinopathy, 3 cases were branch retinal vein occlusion and 3 cases also central retinal vein occlusion. 11 cases were 50 eyes received 4 mg (0.1 ml) of Bevacizumab (Avastin) _ Vision improved in 40 eyes (80%) and 10 eyes (20%) were remained same _ Post injection visual acuity improvement was statistically significant after 1 month and in all the follow up visits thereafter. _ There was statistically significant relationship between periodical injection and improvement in visual acuity. _ PDR was seen in 33 patients. In 27 eyes were improved and 6 eyes were remained same. _ BRVO was seen in 3 patients. In 2 eyes were improved and 1 eye was remained same. _ CRVO was seen in 3 patients. In 2 eyes were improved and 1 eye was remained same. _ ARMD was seen in 11 patients. In 9 eyes were improved and 2 eyes were remained same. CONCLUSION: •Bevacizumab appears to be effective in the management of various retinal vascular diseases. •Improvement in best corrected visual acuity was statistically significant •The effect of Bevacizumab appears to be transient, necessitating repeat injections in case of recurrences. •Complication due to the procedure, such as vitreous hemorrhage and endophthalmitis are very rare. •Bevacizumab seems to be safe therapeutic option in patients who are resistant to conventional laser photocoagulation.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | intravitreal bevacizumab; retinal vascular diseases |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 19 Dec 2017 05:40 |
| Last Modified: | 19 Dec 2017 05:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4348 |
Actions (login required)
 |
View Item |
