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Viviane Mayumi Sakata, Sergio Pimentel, Smairah F Abdallah, Ever C Rodriguez, Carlos E Hirata, Joyce H Yamamoto; Intravitreal Bevacizumab for the Treatment of Choroidal Neovascularization in Vogt-Koyanagi-Harada Disease - A Prospective Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3926.
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Choroidal neovascularization (CNV) in Vogt-Koyanagi-Harada (VKHD) is a complication associated with poor vision. Several treatments have been suggested, though no standard therapy defined. This prospective interventional study assessed the effectiveness of intravitreal (IV) bevacizumab in the treatment of CNV in VKHD.
Patients were diagnosed with VKHD accordingly to Revised Diagnostic Criteria and were followed in the Uveitis Service, Universidade de São Paulo, Brazil. Active CNV was characterized by fundus biomicroscopy, fluorescein angiography (FA) and spectral optical coherence tomography (SOCT). Best corrected visual acuity (BCVA) was measured using Snellen Charts. Disease activity was defined as anterior chamber cells and/or optic disc leakage in FA. Once active CNV was identified, a loading dose of 3 IV bevacizumab injections were scheduled monthly. After the first 3 injections, if intra/subretinal fluid persisted in SOCT, systemic corticosteroid and/or immunosuppressant were indicated, besides IV bevacizumab injection. Main outcome measures were BCVA improvement, decrease in central foveal thickness (SOCT) and absence of intra/subretinal fluid at 6 mo endpoint.
Six eyes of five female patients were included. Mean age was 39.3±14.1 y/o. Two eyes had juxtafoveal, 4 eyes had extrafoveal; one patient presented bilateral CNV. Mean VKHD duration was 32±19.5 mo. Disease was active in 5 eyes and two patients were in use of immunosuppressants on CNV diagnosis. At 6 mo endpoint, all patients were in use of immunosuppressants, two of them associated to oral corticosteroids and one associated to subtenonian corticosteroid injection. VA improvement (0.1±0.1) was observed in 5 eyes (80%). None of the patients presented VA worsening. In two eyes, despite having a final VA better than the baseline, it declined after the third/fourth injection with an increase in intrarretinal fluid at 6 mo. Insufficient immunosuppression or tachyphylaxy were considered.
Monthly IV bevacizumab injections are promptly effective in the treatment of CNV in VKHD. However, anti VEGF injections were necessarily associated with systemic immunossupressive/anti-inflammatory treatment in all cases. CNV in VKHD is aggressive and, despite VA improvement and retinal thickness reduction, intrarretinal fluid was persistent in all eyes at 6 mo endpoint.
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