Effect of intravitreal bevacizumab on the retina ganglion cell layer

Purpose: To investigate the effect of intravitreal (IV) bevacizumab on the ganglion cell layer (GCL) of patients with age-related macular degeneration (ARMD), diabetic macular edema (DME), and retinal vein occlusions (RVO). Methods: A total of 172 charts of patients who presented to the Henry Ford Health System in the year 2016 and received IV bevacizumab were reviewed. Patients who received other IV injections such as steroids, ranibizumab, or aflibercept, and patients who had retinal therapies such as laser or surgery were excluded. Patients were included if they had either ARMD, DME, or RVO including central retinal vein occlusion and branch retinal vein occlusion, and three injections. Both unilateral and bilateral involvement were included. Demographic data, as well as best-corrected visual acuity (BCVA), intraocular pressure (IOP), and GCL average volumes on presentation and after each of the three injections were collected. Changes in GCL volume compared to presentation, and the untreated eye if the condition is unilateral, were analyzed. Correlations between GCL and BCVA or IOP changes were also investigated. Comparisons between RVO, ARMD, and DME were also studied. Results: Fifty eyes from 25 patients were included. Eighteen patients had unilateral disease. There was a statistically significant decrease in GCL volume compared to the initial volume of the same eye after the second and third injections for all subjects. There was also a significant decrease in GCL volume compared to the contralateral eye after the second injection, but not after the third. IOP was inversely correlated with GCL volume after the first and second injection, but not the third. BCVA was inversely GCL volume after the second and third injection, though this varied between diagnoses; eyes with DME had a significant association after each injection; ARMD had a significant association only after the first injection, while RVO had no significant association after any injection. Conclusions: Use of IV bevacizumab has a trend toward greater interval thinning of the GCL in the treated eye, but compared to the untreated eye, this does not remain significant, implying this may be due to the underlying condition. The significance of correlation between improvement in vision and change in GCL volume after treatment varies depending on the condition being treated, suggesting that these diseases respond differently to bevacizumab