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Christopher R. Henry, Robert Sisk, Jonathan Tzu, Thomas Arno Albini, Timothy G Murray, Audina M Berrocal; Intravitreal Bevacizumab for the Treatment of Pediatric Retinal and Choroidal Diseases: Extended Follow Up. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5911.
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To describe the long-term safety and efficacy of off-label intravitreal bevacizumab (IVB) for the treatment of pediatric retinal and choroidal diseases other than retinopathy of prematurity (ROP).
Non-randomized, retrospective case series. Patients younger than 18 years of age treated with IVB between January 1, 2005 and January 1, 2013 were included in the study. Exclusion criteria included a follow up of less than 6 months, a history of ROP, and eyes presenting with light perception or worse vision.
One hundred and four eyes underwent treatment with IVB for the treatment of pediatric retinal and choroidal diseases. Of these, 81 eyes of 77 patients were included in the current study. Average age was 9.1 years (range: 8 months to 17 years) and 45/77 (58%) patients were male. Patients received a mean number of 4.1 injections (range 1-17) and average follow up was 788 days. Primary diagnoses of patients treated with IVB included Coats’ disease (n=30), choroidal neovascular membrane (n=27), familial exudative vitreoretinopathy (FEVR, n=13), cystoid macular edema (n=5), and other (n=6). Average Snellen equivalent visual acuity at presentation was 20/228 and improved to 20/123 at 6 months (p=0.017) and 20/108 at 12 months follow up (p=0.002). Average central foveal thickness improved from 439 microns at presentation to 351 microns at 6 months (p=0.005) and 340 microns at 12 months (p<0.001). Statistically significant visual acuity gains at 12 months were seen in patients with choroidal neovascular membrane (p=0.013), but visual acuity gains did not reach statistical significance for cystoid macular edema (p=0.06), Coats’ disease (p=0.14) or FEVR (p=0.54). The only systemic adverse event identified in the current study was the development of idiopathic intracranial hypertension in an obese 16-year-old female with FEVR. Adverse ocular side effects included ocular hypertension (IOP>30) requiring topical therapy in 8 eyes of 7 patients, of which 5 eyes were on concomitant local or topical corticosteroid therapy. Worsening of tractional retinal detachment was seen in 2 eyes with FEVR.
Patients receiving IVB for the treatment of pediatric retinal and choroidal diseases other than ROP experienced significant visual acuity gains and reductions in central macular thickness. IVB was well-tolerated with minimal side effects noted at a mean follow up of 788 days.
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