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L. P. Latham, R. Windisch, A. Samad; Intravitreal Bevacizumab in the Management of Central Retinal Venous Occlusion. Invest. Ophthalmol. Vis. Sci. 2007;48(13):294.
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To determine the safety and efficacy of intravitreal bevacizumab (Avastin®, Genentech) in the treatment of patients with macular edema and retinal ischemia secondary to central retinal venous occlusion (CRVO).
A retrospective study involving 6 eyes of 6 patients, 2 females and 4 males, with a mean age of 78.2 years (range: 54-89) at the time of diagnosis. Patients had been diagnosed for a median duration of 7 months. No previous treatment had been administered to these patients including laser therapy and intravitreal triamcinolone acetonide. Patients underwent intravitreal injections of 1.25mg bevacizumab at 6 week intervals over a period of 18 weeks. Patients were examined at baseline and at follow-up with assessment of visual acuity (Va), fundus photographs, fluorescein angiography and optical coherence tomography (OCT). Treatment outcomes including Va, foveal thickness (FT), total macular volume (TMV) and vascular leakage were assessed at 18 weeks.
No complications, including inflammation, endophthalmitis, increased intraocular pressure and retinal tears, were observed in any patient. All patients experienced an improvement in vision. Va improved from a mean of 1.35LogMAR (range: 0.7-1.6) at baseline to a mean of 0.8LogMAR (range: 0.3-1.3) at 18 weeks (p=0.028). FT was reduced in all patients from a mean of 550.3µ (range: 175-799) at baseline to a mean of 339.5µ (range: 122-559) at 18 weeks (p=0.007). TMV decreased in all patients from a mean of 12.2mm3 (range: 7.9-15.6) at baseline to a mean of 8.6mm3 (range: 5.97-12.7) at 18 weeks (p=0.007). Fluorescein angiography revealed a marked decrease in retinal hemorrhages and vascular leakage.
Intravitreal bevacizumab appears to be safe and well tolerated in patients with CRVO. Treatment was effective in reducing vascular leakage, macular edema and clinical signs of ischemia. Visual improvement often accompanies these changes. Though the short-term results are favourable, further study is needed to fully elucidate the role of bevacizumab in the treatment of retinal venous occlusions.
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