Purchase this article with an account.
Jella An, Christine Corriveau, Mikael Sebag, Sonia Callejo; Symptomatic Macular Melanocytic Lesions Treated with Intravitreal Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4242.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To review 9 cases of symptomatic macular melanocytic lesions with or without associated choroidal neovascularization (CNV) managed with intravitreal bevacizumab.
All patients were examined by an ophthalmologist and imaged with serial color fundus photography, optical coherence tomography (OCT), fluorescein angiography, and B-scan ultrasonography before and after treatment with intravitreal bevacizumab (1.25mg/0.05cc) on a PRN basis. Treatment outcomes were retrospectively analyzed.
Nine patients with chronic macular choroidal melanocytic lesions presented with acute decrease in vision due to tumor-associated intraretinal and subretinal fluid (SRF), pigment epithelial detachment (PED) and/or subretinal heme (SRH). Tumor location was subfoveal in 5 patients and within 1 disc-diameter of the fovea with extension of fluid into the macula in 4 patients. Two patients had no angiographic evidence of CNV associated with tumor. Initial best-corrected visual acuity (VA) was 20/20 to 20/40 in 3, 20/50 to 20/150 in 5, and 20/200 or worse in 1 case. All patients were followed for minimum of 1 year (range 1-12, mean 3.5 years). After a mean of total 12 injections (range 2-25), final VA improved by mean of 4 lines (range 1-8) in 6 patients and remained unchanged in 3 patients. All 9 cases responded with decreased fluctuation in VA and stabilization of retinal thickness, and OCT revealed complete or partial resolution of SRF, PED and SRH. Among those whose VA improved, 4 patients remained stable over mean 18 months (range 4-36) after mean 9.5 total injections (range 2-25). One patient who failed to respond to a series of 3 injections showed evidence of tumor growth 6 months after the first injection. The patient was treated with radioactive plaque, which resulted in tumor regression, resolution of macular SRF and improvement in VA. The remaining 8 tumors were stable, and there was no other adverse effect from bevacizumab injections.
Intravitreal bevacizumab may be an effective management option for symptomatic macular melanocytic lesions with or without angiographic evidence of CNV. Decrease in large fluctuation of VA and stabilization of retinal thickness was a consistent treatment outcome. Further study will be required to determine a need for an adjuvant consolidation therapy, and a close follow-up and vigilance for tumor growth during and after the therapy will be warranted.
This PDF is available to Subscribers Only