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A. Brock Roller, James C. Folk, Narendra M. Patel, H. Culver Boldt, Stephen R. Russell, Michael D. Abramoff, Vinit B. Mahajan; Subretinal Neovascularization in Idiopathic Juxtafoveal Telangiectasis Responds to Intravitreal Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4521.
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Group 2A idiopathic juxtafoveal telangiectasis (JXT) is a rare condition characterized by parafoveal retinal vascular changes which lead to retinal atrophy and central vision loss. There is no known treatment. Subretinal neovascularization develops in some patients with catastrophic outcomes. We studied the effect of treatment with the anti-vascular endothelial growth factor (anti-VEGF) antibody bevacizumab on retinal thickness and visual acuity in JXT with and without neovascularization. We present to our knowledge the largest study with the longest follow-up yet reported utilizing anti-VEGF therapy to treat JXT.
Retrospective review of patients treated with bevacizumab for JXT. Treatment was performed until no further changes were seen on optical coherence tomography (OCT) after repeated bevacizumab injections. All patients had Snellen visual acuity testing, fundus fluorescein angiography and measurement of central macular thickness (CMT) by OCT at baseline. Visual acuity and CMT were recorded at follow-up visits.
Fourteen eyes of ten patients were included. In five eyes without neovascularization, average follow-up was 17 (±7) months. No eye had improvement in visual acuity or decrease in CMT at final follow-up compared to baseline. In nine eyes with subretinal neovascularization, follow-up averaged 17 (±9) months. At six weeks, CMT decreased 63 (± 58) microns, and acuity improved 1.7 (± 2) lines. At final follow-up, CMT decreased 48 (± 89) microns and acuity improved 1.1 (± 3) lines. Subretinal neovascularization resolved in eight of nine eyes (89%) with proliferative disease after treatment.
Bevacizumab did not improve acuity or reduce retinal thickness in JXT without neovascularization at final follow-up. Anti-VEGF therapy may have no role in the treatment of typical JXT without neovascularization. However, in JXT with subretinal neovascularization, bevacizumab caused involution of neovascular membranes and stable to improved visual acuity in nearly all patients. We feel that anti-VEGF agents are the treatment of choice for neovascularization in this rare disease.
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