VISUAL OUTCOME AND CHANGES IN CENTRAL MACULAR THICKNESS FOLLOWING INTRA-VITREAL AVASTIN INJECTION FOR PATIENTS WITH MACULAR EDEMA AT MUHIMBILI NATIONAL HOSPITAL

MEDICINE

Introduction: Macular edema is a condition whereby there is retinal thickening on the macular area, leading to vision loss among patients with metabolic disorders, particularly diabetic retinopathy. For a long time, argon laser photocoagulation has been the mainstay treatment for macular edema; however, the introduction of anti-vascular endothelial growth factor drugs like Avastin has revolutionized its treatment. Despite this significant progress, gaps and challenges persist in the use of intra-vitreal Avastin injection for the treatment of macular edema due to scarcity of data on the outcome of this treatment especially on central macular thickness changes and visual outcome in developing countries including Tanzania. This study aimed to determine the visual outcome and central macular thickness changes following intra-vitreal avastin injections for the patients with macular edema attending the retina clinic at Muhimbili National Hospital. Methods: A Hospital based Prospective cohort study of 37 newly diagnosed patients with macular edema who were treated with intra-vitreal avastin injection during study period were consecutively recruited. Patient’s visual acuity and Optical coherence tomography were done before intra-vitreal avastin injection and prior to the next injection on follow up visit. Results: A total of 37(58eyes) newly diagnosed patients with macular edema were studied; where 10 eyes received one injection, 21 eyes received two injections, and 27 eyes received all three injections depending on response to treatment. However, 9 eyes did not respond to three injections and were given more injections. The mean best corrected visual acuity changed significantly (p<0.001) from 0.72(±0.086) log MAR at baseline to 0.69(±0.073), 0.66 (±0.164) and 0.62(±0.206) log MAR after one, two and three intra-vitreal avastin injections respectively. The central macular thickness decreased significantly (p<0.001) with increasing number of intra-vitreal avastin injections, where the mean CMT changed from 400(±63.44)μm at baseline to 311(±53.65)μm, 269.5(±84.47)μm and 216(±79.62)μm after one, two and three intra-vitreal avastin injections. Conclusion: Visual acuity improved significantly with the increasing number of injections. Half of the eyes presented with thick central macular thickness decreased significantly with increasing number of injections. Majority of eyes with diabetic retinopathy and CRVO responded well with three intra vitreal avastin injections.

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