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Wael Abdelghani, Elmira Ramos, Hebatullah Tawfik; Treatment of central serous chorioretinopathy using anti-vascular endothelial growth factor. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3726.
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© ARVO (1962-2015); The Authors (2016-present)
It has recently been proposed that anti-vascular endothelial growth factors (anti-VEGF) may accelerate the resolution of central serous chorioretinopathy (CSCR) but evidence in the literature is insufficient. We report our experience and outcomes following the use of intravitreal bevacizumab (anti-VEGF) in the management of CSCR.
We conducted a retrospective chart review to examine the effect of the intravitreal injection of bevacizumab on the resolution of CSCR. Sixteen patients presenting with symptomatic CSCR that were treated with 1.25 mg intravitreal injection of bevacizumab between 2012 and 2014 were identified. Two patients had CSCR OU. All patients underwent a complete dilated eye exam, fluorescein angiogram and Ocular Coherence Tomography. Outcome measures were improvement in best corrected visual acuity (BCVA) and decrease in central macular thickness (CMT). We compared BCVA and CMT before bevacizumab injections and at first follow-up (average 12 days) and second follow-up (average 54 days).
Four patients had recurrent CSCR and 5 were chronic cases that had not resolved in more than 3 months. Ten patients were males, 6 were females and the mean age at presentation was 46.7 years. The mean BCVA at presentation was 0.52 logarithm of the minimum angle of resolution (logMAR) (±0.36). There was a significant improvement in BCVA at the first follow up visit, with a mean BCVA of 0.41 (logMAR) (±0.32), p=0.03. Improvement in visual acuity was observed within 1-2 weeks in 33.3% of cases and within 3-4 weeks in 50% of cases. A decrease in CMT was observed in 9 of the 18 eyes on the first follow-up visit. The mean CMT thickness at presentation was 407.3µm (±167.5). The mean CMT at the first follow-up visit was 394 µm (±149.7), p=0.44. Mean CMT at second follow-up was 312.4 µm (±59.9), p=0.03.
Our observations indicate that treatment of CSCR with bevacizumab (anti-VEGF) results in rapid improvement in visual acuity. Normally resolution of symptoms from CSCR takes several months. Because increased vascular permeability has been implicated as a possible pathologic mechanism in CSCR, treatment using anti-VEGF agents is a rational approach. Treatment with bevacizumab may be an efficient way to treat CSCR, decrease the resolution time and improve vision. We recommend the development of large randomized controlled trials that compare this approach to other treatment approaches.
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