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K. Julian, C. Fardeau, C. Terrada, C. Francais, P. LeHoang, B. Bodaghi; Intravitreal Bevacizumab as Primary Treatment for Choroidal Neovascularization Secondary to Uveitis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6034.
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To evaluate the short term safety and efficacy of intravitreal (IVT)bevacizumab as primary treatment for choroidal neovascularization (CNV)secondary to uveitis.
Files of patients with uveitis who received one or more 1.25mg/0,05ml IVT bevacizumab treatment for CNV were reviewed for clinical findings,best-corrected Snellen visual acuity (BCVA), fluorescein angiography (FA) and optical coherence tomography (OCT),concurrent treatments,number and frequency of IVT bevacizumab and treatment related adverse events. Patients previosuly treated with photodynamic therapy or IVT corticosteroids were excluded.
12 patients (F/M: 7/5, median age 46.6 years) were included. Multifocal choroiditis and panuveitis was the underlying disease in 5 cases followed by idiopathic inflammation in 3 cases, and for the 4 remaining, ampiginous choroiditis, serpiginous choroiditis, sympathetic ophthalmia and tuberculous uveitis were identified. 11 patients (91.66%) had a significant decrease in central foveal thickness by the end of the follow up (median pre-treatment OCT 254.66µ, median post-treatment OCT 188.25µ), 1 patient had no change. BCVA improved in 10 patients (83.33%), remained unchanged in 1 (8.33%) and worsened in 1 (8.33%).All but two were under systemic immunosupression by the time injections were given; steroid pulse therapy followed by oral tappering was the main systemic treatment in 6 patients (60%); in 4, other immunosupressants were added (azathioprine in 3, IFN2a in 1). 4 patients received a single subtenon Triamcinolone Acetonide injection the same day of the IVT Bevacizumab. Median number of IVT Bevacizumab was 2.58 (1-5) in those receiving more than one injection (8 patients) and the mean frequency was 10.3 weeks. No adverse event was related to bevacizumab nor to the injection procedure. Median follow up was 27.75 months (4-90 months).
IVT bevacizumab was an effective and safe treatment for inflammatory CNV in terms of improvement in visual acuity and macular thickness, in patients with adequate control of intraocular inflammation. Most patients needed more than 2 injections to achieve a clinical response, but further work is mandatory to determine their number and frequency.
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