Improvement of Diabetic Macular Edema in the Fellow Eye After Monocular Intravitreal Bevacizumab Injection

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Introduction
Bevacizumab is a recombinant humanized monoclonal antibody directed against human vascular endothelial growth factor (VEGF). 1 Recent studies have demonstrated the beneficial effects and safety of anti-VEGFs in the treatment of diabetic macular edema (DME). 2,3Bilateral injection of anti-VEGFs is usually performed, because DME frequently presents bilaterally. 4There are reports of therapeutic effects in the fellow eye after the monocular injection of anti-VEGFs, including decreased fluorescein leakage in the fellow eye after intravitreal injection of 1.25 mg of bevacizumab in patients with DME. 5 The current study describes an interesting case of significant improvement of DME in the contralateral eye after the monocular intravitreal injection of bevacizumab.2A & B).The patient was not conferring for further follow up.

Discussion
Today, the potential effect of unilateral injection of anti-VEGFs in the fellow eye is controversial.In a prospective study, Gamulescu and Helbig showed no effects in the fellow eye of 26 eyes with bilateral neovascular age-related macular degeneration treated with ranibizumab. 6Another study by Velez-Montoya et al showed that unilateral bevacizumab injection in 23 patients with bilateral DME had no effect on the fellow eye. 7everal studies have demonstrated the potential effects of unilateral anti-VEGF injection in fellow eye; for example, Hanhart et al reported that unilateral bevacizumab injection in patients with bilateral DME is often associated with bilateral response. 4Zlatcavitch et al reported a patient with progression to macula-off tractional retinal detachment in a contralateral eye within 7 days after intravitreal injection of bevacizumab. 8Wu et al described a patient with macular edema due to branch retinal vein occlusion (BRVO) in the right eye and choroidal neovascularization in the left eye.They showed that intravitreal injection of bevacizumab in the right eye resulted in a reduction in macular edema in the left eye and vise versa. 9ecent studies have revealed that the anti-VEGF concentration in the fellow eye increased after unilateral injection.The peak concentration of bevacizumab in the aqueous humor of the fellow eye after the unilateral injection of 1.25 mg bevacizumab occurred 7 days after injection 10,11 ; about 4 weeks after injection, peak concentration of bevacizumab occurred in the vitreous of the fellow eye. 10 In this study, we report a patient with bilateral DME in which significant improvement in macular edema was seen after the intravitreal injection of 1.25 mg of bevacizumab in the contralateral eye.Therefore, therapeutic effects of bevacizumab in the fellow eye are possible, and further research is required to document such fellow eye effects.Unilateral injection of anti-VEGFs for bilateral disease, if probable, can lead to a reduction of costs and complications.

Conclusion
The unilateral injection of intravitreal bevacizumab may have therapeutic effects in the fellow eye and reduce the http://www.jhpr.irHosp Pract Res.2017 May;2(2):54-55 doi 10.15171/hpr.2017.13Case Report HPR Hospital Practices and Research was performed in the right eye.Two months later the patient presented for examination, and OCT was done.Surprisingly, significant improvement of DME had occurred in both eyes, including the left eye that had not received intravitreal injection.Central macular thickness was 245 µ in the right eye and 250 µ in the left eye (Figures

Figure 1 .
Figure 1.Optical Coherence Tomography of the Right Eye (a) and Left Eye (b) Before Treatment.

Figure 2 .
Figure 2. Optical Coherence Tomography of the Right Eye (A) and Left Eye (B) After Intravitreal Injection of 1.25 mg Bevacizumab in the Right Eye.