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Paola A. Salvetti, Laura de Polo, Alessandra Acquistapace, Giovanni Staurenghi; The Effect Of Bevacizumab On Retinal Ischemia In Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2012;53(14):961.
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to evaluate the effect of intravitreal injection of bevacizumab on the onset and progression of retinal ischemia in central retinal vein occlusion (CRVO) compared to the natural history of the disease.
retrospective analysis of fluorescein angiography( FA) images of 16 eyes of 16 consecutive patients with diagnosis of CRVO. Intravitreal injection of bevacizumab (IVB) was performed in case of macular edema and hemorrhages persistence and/or patients lost of 3 or more ETDRS lines in visual acuity. The IVB were performed at the onset or within 3 months diagnosis. We excluded patients presenting at the onset ischemia or wide hemorrhages hiding ischemic areas and ischemia related to other retinopathy causes. FA images were analyzed by two retina specialists (LdP, PS) in order to identify the non-perfusion progression at baseline and at 1 year follow-up. Agreement by two different operators was calculated with Cohen’s K test. The progression rate of retinal ischemia during 13-month follow-up was analyzed.According to literature, CRVO was defined ischemic when more than 10 optic disc areas of retinal capillary non-perfusion were detected. Finally the number of ETDRS fields involved in the ischemic patient group was analyzed.
the mean number of IVB performed was 2.5 (range 1-5). At 13 month follow-up 50% of eyes (8/16) developed ischemia in more than 10 optic discs confluent areas. Besides, the natural history of the disease shows that 27% of patients develop retinal ischemia after 13 months. The strenght of agreement between operators was 0.80 = substantial, according to the classification of Landis and Coch. When considering the subgroup analysis we observed that 13 % (2/16) of eyes developed mild ischemia (4-5 ETDRS fields involved), 25% (4/16) of eyes developed ischemia in the entire periphery, 13% (2/16) of eyes developed ischemia in the entire periphery and in the macula.
in this study the percentage of patients developing retinal ischemia after IVB was higher compared to the percentage observed in the natural history of the disease. This may suggest a role of bevacizumab in increasing retinal ischemia. Further clinical study are needed to evaluate a larger number of patients.
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