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J. Hsu, R.S. Kaiser, A. Sivalingam, P. Abraham, M.S. Fineman, M.A. Samuel, J.F. Vander, A.C. Ho; Intravitreal Bevacizumab (Avastin®) in Central Retinal Vein Occlusion . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4300.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the effects of intravitreal Bevacizumab in patients with macular edema and/or neovascular glaucoma (NVG) resulting from central retinal vein occlusions (CRVO).
Retrospective case series of 11 eyes of 11 patients diagnosed with macular edema and/or NVG due to CRVO who subsequently underwent intravitreal injection of Bevacizumab at the Retina Service of Wills Eye Hospital or Black Hills Regional Eye Institute between August 2005 and November 2005.
Four male and seven female patients with an average age of 72.5 years (range=64–84) underwent intravitreal injection of Bevacizumab. Prior to injection, mean visual acuity was 20/308 ± 4.2 lines (range: 20/50 – 4/200). One week following injection, mean visual acuity was 20/211 ± 5.6 lines (range: 20/20 – 3/200, P = 0.07). Seven of the 11 patients (64%) had an improvement in vision. Eight of the 11 patients completed at least 4 weeks of follow–up and had a mean visual acuity at the last examination of 20/198 ± 5 lines (range=20/20 – 6/200, P = 0.036). Six of the 8 patients with 4 weeks of follow–up (75%) maintained improved vision compared with the pre–injection acuity. OCT was available for 4 of the 11 patients. Mean OCT central retinal thickness was 501 ± 122 at baseline. Mean OCT central retinal thickness decreased to 235 ± 136 four weeks post–injection (P < 0.0002). One patient with NVG resulting from CRVO was included in this study. Pre–injection intraocular pressure was 28, and one–week post–injection intraocular pressure was 20 with no panretinal photocoagulation laser performed.
Currently, no treatments are proven to be consistently effective for patients with macular edema secondary to CRVO. Intravitreal triamcinolone acetonide has been beneficial in some cases, but its effects are inconsistent, unproven and associated with complications including up to 40% with elevated intraocular pressure. This initial report demonstrates early and clinically relevant benefits from Bevacizumab injections for complications of CRVO; vision improved and macular edema decreased. No significant systemic or ocular side effects were demonstrated. Intravitreal Bevacizumab may be an effective treatment for persistent macular edema due to CRVO. Larger clinical studies with long–term follow–up will be necessary to elucidate the role of intravitreal Bevacizumab in treating eyes with CRVO.
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