J Korean Ophthalmol Soc.  2013 Aug;54(8):1298-1302.

Intravitreal Bevacizumab Injection in Diabetic Papillopathy

• Shin JH
• Choi KS

Abstract

PURPOSE
To report a case where intravitreal bevacizumab injection was an effective treatment for diabetic papillopathy in a type 2 diabetic patient.
CASE SUMMARY
A 47-year-old male with a 10-year history of diabetes mellitus type 2 presented to our clinic for evaluation of diabetic retinopathy. There were no subjective symptoms including blurred vision or visual defect, and best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/30 in the left eye. Fundus examination showed hyperemic optic disc swelling with telangiectatic new vessels, and fluorescein angiography leakage from the optic disc with neovascularization. The patient underwent fractionated panretinal photocoagulation. Ten days later, he complained of painless blurred vision with significant optic nerve head swelling and BCVA was 20/80 in the left eye. Intravitreal bevacizumab injection was administered, optic disc swelling was significantly decreased and BCVA improved to 20/30 after two months.
CONCLUSIONS
Diabetic papillopathy with severe decreased visual acuity can be treated with intravitreal bevacizumab injection.

Keyword

Bevacizumab injection; Diabetic papillopathy

MeSH Terms

Antibodies, Monoclonal, Humanized
Diabetes Mellitus
Diabetic Retinopathy
Eye
Fluorescein Angiography
Humans
Light Coagulation
Male
Optic Disk
Vision, Ocular
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized

Figure

• 

  Figure 1. (A) Fundus photography showing the optic disc swelling in the left eye at patient’s first visit. (B) Early phase fluorescein angiography shows the optic-disc leakage due to neovascularization.

• 

  Figure 2. (A) At 10 days after initial presentation, fundus photography shows marked the optic disc swelling and hemorrhage in the left eye, with decreased visual acuity. (B) Fluorescein angiography shows hyperfluorescence on the optic disc early phase, (C) leakage from telangiectatic vessels, late phase. (D) After intravitreal bevacizumab injection, there is significantly reduced swelling of the optic disc. BCVA improved from 20/400 to 20/30.

• 

  Figure 3. (A) SD-OCT showed hyporeflective subfoveal space and macular edema, which continued as the optic disc swelling in the left eye at patient’s first visit. (B) Two months after treatment, hyporeflective subfoveal space and macular edema were resolved in the left eye.

Reference

References

1. Lubow M, Makley TA Jr. Pseudopapilledema of juvenile diabetes mellitus. Arch Ophthalmol. 1971; 85:417–22.

2. Appen RE, Chandra SR, Klein R, Myers FL. Diabetic papillopathy. Am J Ophthalmol. 1980; 90:203–9.

3. Regillo CD, Brown GC, Savino PJ. . Diabetic papillopathy. Patient characteristics and fundus findinga. Arch Ophthalmol. 1995; 113:889–95.

4. Bayraktar Z, Alacali N, Bayraktar S. Diabetic papillopathy in type II diabetic patients. Retina. 2002; 22:752–8.

5. Heller SR, Tattersall RB. Optic disc swelling in young diabetic patients: a diagnostic dilemma. Diabetes Med. 1987; 4:260–4.

6. Hayreh SS. Anterior ischemic optic neuropathy. Arch Neurol. 1981; 38:675–8.

7. Hayreh SS, Zimmerman MB. Nonarteritic anterior ischemic optic neuropathy: clinical characteristics in diabetic patients versus non-diabetic patients. Ophthalmology. 2008; 115:1818–25.

8. Ostri C, Lund-Andersen H, Sander B. . Bilateral diabetic pap-illopathy and metabolic control. Ophthalmology. 2010; 117:2214–7.

9. Grunwald JE, Brucker AJ, Braunstein SN. . Strict metabolic control and retinal blood flow in diabetes mellitus. Br J Ophthalmol. 1994; 78:598–604.

10. Larsen M. Unilateral macular oedema secondary to retinal venous congestion without occlusion in patients with diabetes mellitus. Acta Ophthalmol Scand. 2005; 83:428–35.

11. Yang DW, Lee SH, Kim IT, Yun SU. Bilateral diabetic anterior is-chemic optic neuropathy. J Korean Ophthalmol Soc. 2004; 45:333–9.

12. Whittaker KW, Mehta JS, Tsaloumas MD. Bilateral diabetic pap-illopathy associated with optic disc neovascularisation. Eye (Lond). 2000; 14:(Pt 6). 914–5.

13. Al-Haddad CE, Jurdi FA, Bashshur ZF. Intravitreal triamcinolonce acetonide for the management of diabetic papillopathy. Am J Ophthalmol. 2004; 137:1151–3.

14. Ornek K, Oğurel T.Intravitreal bevacizumab for diabetic papillo-pathy. J Ocul Pharmacol Ther. 2010; 26:217–8.

15. Al-Dhibi H, Khan AO. Response of diabetic papillopathy to intra-vitreal bevacizumab. Middle East Afr J Ophthalmol. 2011; 18:243–5.

16. Willerslev A, Munch IC, Larsen M. Resolution of diabetic papill-opathy after a single intravitreal injection of ranibizumab. Acta Ophthalmol. 2012; 90:e407–9.

17. Van Bruggen N, Thibodeaux H, Palmer JT. . VEGF antago-nism reduces edema formation and tissue damage after ischemia/ reperfusion injury in the mouse brain. J Clin Invest. 1999; 104:1613–20.

18. Gunther JB, Altaweel MM. Bevacizumab (Avastin) for the treat-ment of ocular disease. Surv Ophthalmol. 2009; 54:372–400.