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Hee Jung Kwon, Hae Min Kang, Hyesun Kim, SungChul lee, Christopher Lee; The Growth of Small Choroidal Melanocytic Lesion after Intravitreal Bevacizumab Injection. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5896.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the clinical effect of intravitreal bevacizumab injection (IVB) for small choroidal melanocytic lesions with subretinal fluid and to determine features that are predictive of growth into choroidal melanoma.
The medical records of 34 patients who diagnosed with small choroidal melanocytic lesion between December 2004 and October 2011 were retrospectively reviewed. Univariate logistic regression was performed to evaluate the degree of relationship of initial clinical findings (tumor size, symptom, surface features [orange pigment, drusen and RPE alteration], subretinal fluid [SRF]) to tumor growth. We also describe the clinical course of small choroidal melanocytic lesion treated with intravitreal injection of bevacizumab (IVB) for the purpose of decreasing SRF.
Six patients of small choroidal melanocytic lesions (17.6%) demonstrated growth. Lesions that demonstrated growth had significantly higher rate of thicker tumor (>2.0mm, 83.3% vs. 28.6%, p=0.018) and orange pigment (83.3% vs. 21.4%, p=0.018). Ten patients were treated with IVB, but IVB had minimal effect in reducing SRF and six (60%) of them showed tumor growth. We could calculate tumor growth rate in 3 patients, and tumors growth rate accelerated after cessation of serial IVB. Histopathologic finding of enucleated eye with enlarged tumor after IVB confirmed choroidal melanoma and showed severe necrosis coinciding necrotic type choroidal melanoma.
Intravitreal injection of bevacizumab seems to be inefficacious in resolving subretinal fluid accompanied with small choroidal melanocytic lesion. Moreover, IVB seems to stimulate tumor growth by disrupting homeostasis of vascular endothelium growth factor and other mediators. Therefore, the use of bevacizumab for treatment of SRF in choroidal melanoma should be considered carefully because of the possible adverse effects of IVB.
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