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J. A. Feistmann, E. W. Fitz, T. O. Muldoon, J. B. Walsh, R. C. Gentile, R. B. Rosen; Avastin for the Treatment of Chronic Central Serous Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4150.
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Intravitreal Avastin® (Genentech) is now accepted clinical practice in the treatment of many retinal disorders that manifest in macular edema in which vascular hyperpermeability and VEGF play roles in the pathogenesis. Central serous chorioretinopathy has been postulated to result from vascular hyperpermeability in the choroidal vasculature leading to increased hydrostatic pressure in the choroid and ultimately disruption of the RPE. The purpose of this investigation is to present four cases of chronic central serous chorioretinopathy treated with Avastin.
A retrospective chart review was done of three patients with chronic central serous chorioretinopathy with decreased Snellen visual acuity for at least one year in which four eyes were treated with intravitreal injections of 1.25mg in 0.05mL of Avastin. The Snellen visual acuity, subjective vision, and SLO-OCT of the macula had been recorded at baseline and either weekly or monthly after the injection, and in one case, on day 1 post injection. Fluorescein angiography was done at baseline, but not at the follow up visits. Two of the four eyes had prior focal treatment in the same eye that was given Avastin.
The left eye of Patient 1 improved 2 lines in Snellen visual acuity two weeks after Avastin OS, but the SLO-OCT of the macula OS showed no decrease in subretinal fluid (SRF). During that time, the SLO-OCT of the untreated right eye showed a decrease in SRF and the vision improved 1 line OD. Patient 2 was given Avastin OS and the vision improved 1 line in one month. Additionally, the SLO-OCT of the macula OS showed resolution of SRF. However, the vision of the untreated right eye of Patient 2 worsened from 20/50 to count fingers and there was an increase in SRF on SLO-OCT OD. The right eye of Patient 2 was then injected with Avastin. One month later, the vision improved to 20/400 OD, but there was no decrease in SRF on SLO-OCT OD. Patient 3 was given Avastin OD and the vision improved 1 line on day one, and remained stable on week one, two and three. The SLO-OCT of the macula OD, however, remained unchanged with persistent subfoveal fluid noted at each follow-up visit. No adverse events occurred in any patient.
Although the initial responses were promising, the results were not consistent nor as dramatic as they have been for other disease processes treated with Avastin. However, Avastin is relatively safe and remains a potential option for patients with vision loss from chronic central serous chorioretinopathy not responsive to other treatments, but needs further study with a larger sample size.
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