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Augustine R. Hong, Igor Bussel, John M. Roberts, Jr., Geoffrey Hill, Richard M. Ahuja; Intravitreal Bevacizumab In The Treatment Of Macular Edema Secondary To Central Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2012;53(14):916.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the visual outcome and macular thickness in patients with macular edema secondary to central retinal vein occlusion (CRVO) treated with primary intravitreal bevacizumab (IVB).
We conducted a retrospective review of patients who presented to Stroger Cook County Hospital with macular edema secondary to CRVO from June 2009 to November 2011. All patients underwent complete ophthalmic examination, fluorescein angiography and Stratus optical coherence tomography. All patients received one or more injections of 0.05 ml of 1.25mg/0.05 ml of IVB. Inclusion criteria were visual acuity ≤ 20/40 and central macular thickness (CMT) ≥250 µm. Exclusion criteria included any other etiology of macular edema and previous treatment including focal laser or other intravitreal medications. Snellen visual acuity was converted to logMAR for statistical analysis.
A total of 22 eyes of 21 patients were included in our study. The mean number of IVB injections was 4 (range 1 to 10) with a mean follow-up of 12 months (range 2 to 29 months). We divided the patients into 2 groups based on visual acuity. Group A included 12 eyes with initial vision <20/400; Group B included 10 eyes with initial vision ≥20/400. Panretinal photocoagulation was performed in 6 of 12 eyes in Group A and in one patient in Group B. In Group A, 10 of 12 eyes (83%) had improved vision, with mean visual acuity increasing an average of 5.1 lines (p=0.004). Mean CMT in Group A decreased from 625µm to 319µm (p=0.007). In Group B, 9 of 10 eyes (90%) had improved vision, with mean visual acuity increasing an average of 2.6 lines (p=0.04). Mean CMT in Group B decreased from 871µm to 490µm (p=0.006). No patients experienced adverse effects related to IVB.
Our study shows that IVB improves visual acuity and decreases macular thickness in patients with macular edema secondary to CRVO. These findings were consistent in both groups A and B despite differences in initial visual acuity. Although initial visual acuity <20/400 (Group A) is a poor prognostic factor and suggestive of an ischemic CRVO, 10 of 12 eyes (83%) in this group had improved vision, 8 of which improved at least 3 lines. The optimal number and frequency of IVB injections in the management of macular edema secondary to CRVO needs further study.
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