Bevacizumab Injections for Retinal Diseases in Nepal

Bevacizumab is a medicine that targets a specific protein called vascular endothelial growth factor A (VEGF-A). This medication is primarily used to treat advanced colon cancer but has also been used in other eye diseases. Studies have shown that its safety and effectiveness are similar to another drug called ranibizumab.

The use of bevacizumab injections in the eye is common for various conditions, including Diabetic Retinopathy (a diabetes-related eye problem), Macular Edema, and other vision-threatening issues. These eye diseases affect a lot of people and can lead to serious loss of sight. Research from Nepal has shown that the number of people with retinal diseases has significantly increased, especially among the elderly.

#What Is Bevacizumab Used For?

Injections of bevacizumab into the eye are used for several retinal diseases:

• Proliferative diabetic retinopathy
• Diabetic macular edema
• Choroidal neovascularization
• Retinopathy of prematurity
• Macular edema due to Retinal Vein Occlusion
• Iris neovascularization
• Neovascular glaucoma
• Pseudophakic macular edema

These conditions can lead to significant vision loss and represent major causes of blindness worldwide.

#Background on Retinal Diseases in Nepal

Retinal diseases are a leading cause of blindness globally. In Nepal, a study found that the prevalence of these diseases among older people has increased dramatically. After cataracts, retinal diseases are the second most common cause of blindness in the country.

Bevacizumab has been found to lower VEGF levels in diabetics and is less invasive than other treatments, reducing the need for more complicated surgeries. Other studies have shown patients with retinal vein occlusion improve after receiving these injections.

The study we conducted looked specifically at the use of bevacizumab in treating various retinal diseases in the Hetauda region of Nepal.

#Study Details

#Ethics Approval

Before the study began, we received ethical approval from the Tilganga Institute of Ophthalmology.

#Study Setup

We looked back at patients treated with intravitreal bevacizumab (IVB) at Hetauda Community Eye Hospital from 2019 to 2022. Data collection started on November 5, 2023. We gathered information on Visual Acuity, eye pressure, eye exams, and central macular thickness using specialized equipment.

#Injection Process

All injections were done in a controlled setting. A specific method was used to prepare and administer the injections safely. After the injection, patients received instructions for care and monitoring for potential warning signs.

#Data Analysis

After gathering data, we analyzed it using computer software. We looked for significant differences in vision and central macular thickness before and after the treatment.

#Results of the Study

We reviewed a total of 418 injections given to 247 patients. After considering those who didn’t follow up, we were left with 234 eyes of 221 patients. The average age of these patients was about 64 years, and most were male.

The study found that the most common reason for receiving injections was diabetic retinopathy, accounting for a significant portion of the cases. Other reasons included age-related macular degeneration and retinal vein occlusion.

#Changes in Central Macular Thickness and Visual Acuity

Before treatment, the average thickness of the central macula was measured. After treatment, a significant reduction in thickness was seen in some conditions, particularly branch retinal vein occlusion. However, overall visual acuity did not show a significant improvement for all conditions treated.

This study highlighted that while IVB injections led to improvements in some patients with diabetic retinopathy and branch retinal vein occlusion, not all conditions responded equally.

#Discussion of Findings

#Importance of the Study

This study is important as it provides insights into how effective IVB injections are for a variety of retinal diseases in this specific region. It emphasizes the need for continued access to such treatments in areas where healthcare resources may be limited.

#Comparing to Other Studies

The findings align with other studies showing that diabetic retinopathy is a leading cause for these types of injections. Many patients in our study experienced improved outcomes, particularly those with diabetic retinopathy.

Interestingly, age-related macular degeneration was the second most common reason for treatment in our study, which is not always the case in other regions where it often ranks third. This highlights how local health issues can vary, possibly due to different demographic factors.

#Other Conditions Treated

Retinal vein occlusion was another common condition treated with IVB injections in our study. While there was improvement seen in some cases, others did not improve, indicating that not all patients respond the same way to the treatment. This could be due to factors like the specific type of vein occlusion or timing of the treatment.

#Limitations

While our study provides valuable data, it was retrospective, meaning we looked back at past records. This approach has its limitations, particularly regarding how follow-up care was structured.

#Conclusion

In conclusion, our study indicates that intravitreal bevacizumab injections can lead to meaningful improvements in patients with various retinal diseases, especially diabetic retinopathy. However, responses can vary significantly between different conditions.

As populations age and the incidence of retinal diseases increases, having effective treatment options like IVB becomes increasingly important. Continued research in this area will be essential to ensure that patients receive the most effective care possible.

#Strengths and Limitations of the Study

The study shows that comprehensive ophthalmologists can provide effective treatment in community settings, which is crucial for reducing vision loss due to retinal diseases. Accessibility, expertise, and cost-effectiveness were highlighted as strengths.

However, one of the main limitations was the retrospective nature of the study, which means that more research with longer follow-up times is needed. There is also a need for additional studies to confirm these findings and explore the effectiveness of IVB injections across different regions and populations.