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World J Diabetes. Apr 15, 2013; 4(2): 19-26
Published online Apr 15, 2013. doi: 10.4239/wjd.v4.i2.19
Bevacizumab for the management of diabetic macular edema
Francisco Rosa Stefanini, J Fernando Arevalo, Maurício Maia
Francisco Rosa Stefanini, Maurício Maia, The Retina Division, Ophthalmology Department, Federal University of São Paulo, São Paulo, SP 04023-062, Brazil
J Fernando Arevalo, The Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
J Fernando Arevalo, The King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
Maurício Maia, Brazilian Institute of Fighting Against Blindness, Assis/Presidente Prudente, São Paulo, SP 04023-062, Brazil
Author contributions: Stefanini FR reviewed the literature and wrote the first draft of the manuscript; Arevalo JF and Maia M contributed equally to the literature search and reviewed the draft and revised versions of the manuscript; all authors approved the final version of the manuscript to be published.
Correspondence to: Francisco Rosa Stefanini, MD, The Retina Division, Ophthalmology Department, Federal University of São Paulo, Rua Botucatu, 821, Vila Clementino, São Paulo, SP 04023-062, Brazil. franstefanini@yahoo.com.br
Telephone: +55-11-50852010 Fax: +55-11-50852000
Received: October 24, 2012
Revised: February 15, 2013
Accepted: March 23, 2013
Published online: April 15, 2013
Abstract

Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.

Keywords: Diabetic macular edema, Bevacizumab, Anti-vascular endothelial growth factor, Diabetic retinopathy

Core tip: This review summarizes the studies examining bevacizumab for the management of diabetic macular edema (DME), focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity.