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J. Taylormoore, B.E. Jones; Intravitreal Bevacizumab in the Treatment of Retinal Vein Occlusion Associated CME . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4268.
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To examine the effects of intravitreal Bevacizumab in patients with retinal vein occlusion (RVO) and cystoid macular edema (CME). Vascular Endothelial Growth Factor (VEGF) is a known mediator of vascular leakage associated with RVO. Bevacizumab (Avastin, Genentech) is a recombinant Humanized, full length, anti–VEGF monoclonal antibody that binds to all isoforms of VEGF–A.
This is a retrospective interventional case series of 4 patients, aged 66 to 82, with RVO–associated CME who were treated with intravitreal Bevacizumab. Patients with retinal vein occlusion were chosen for treatment on the basis of clinical CME present for more than 3 months with associated decreasing vision. Pre–treatment visual acuity (VA) ranged from 20/60 to 5/200. Baseline best–corrected VA, FA, blood pressure and medical history were obtained in all patients, and ocular coherence tomograohy (OCT, Zeiss) was obtained when available. An expanded consent with off–label use waiver and information letter was reviewed with all patients. Recent or planned surgery and potential pregnancy were absolute contraindications for treatment. The treatment eye was prepped using topical anesthetic and fluoroquinolone antibiotic drops followed by 5% betadine. A trans pars–plana intravitreal injection of 1.0 mg (0.04 ml of 25 mg/ml) Bevacizumab was performed followed by antibiotic drops QID for 1 week. Follow up was planned at one and six weeks with FA obtained at 6 weeks.
One week follow up was obtained in all 4 patients with improved vision of 1 Snellen line seen in 1 patient. OCT was obtained in 2 of 4 patients, showing stable CME. Six week follow up was obtained in 3 of 4 patients, with 3 to 4 Snellen lines of improvement in best corrected VA seen in 2 patients. FA in 2 patients showed decreased leakage. There was no change in FA in 1 patient. OCT obtained in 1 patient showed no change. One patient was re–examined at 9 weeks and showed 4 Snellen lines of decreased VA, PSC cataract, and trace vitritis. No systemic events occurred.
Intravitreal Bevacizumab can result in reduced FA leakage and improved VA in patients with RVO–associated CME. Decreased macular FA leakage can also be seen without a corresponding improvement in VA. More follow up is needed to evaluate the safety and efficacy of intravitreal Bevacizumab as a treatment for RVO–associated CME.
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