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F. Ziemssen, F. Gelisken, M. Voelker, W. Inhoffen, S. Grisanti, K. U. Bartz-Schmidt; Long-Term Follow-Up of Intravitreal Bevacizumab in Serous Retinal Pigment Epithelial Detachment. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5002.
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Retinal pigment epithelial detachment (PED) without detectable choroidal neovascularization (CNV), so-called non-vascularized or pure serous PED, accounts for a small portion of age-related pigment epithelial detachment. Though intravitreal bevacizumab (Avastin®) therapy has been proven to provide anti-exudative potential even in non-proliferative retinal diseases, the benefit has still to be clarified for the treatment of pure serous PED.
Patients with pure serous PED were included after treatment with injections of 1.25 mg bevacizumab in the retrospective analysis. Concomitant CNV was excluded by ocular coherence tomography (OCT), fluorescence angiography (FA) resp. indocyanine green angiography (ICG). Lesions with a follow-up of less than 24 months subsequent the first injection were disregarded. The decision for re-injection was made in dependence on the OCT findings and the functional development. Treatment was also offered even if the serous PED or the overlying retinal edema were unchanged after the first injection. Aside from visual acuity, central retinal thickness and the height of PED were measured as secondary outcome. We tested for the change in the time course using Wilcoxon Signed-Rank test (alpha=0.05).
Median age of the case series was 75 years (range: 61 - 84). During a follow-up of 24 months, a mean number of 5.3 injections were administered per eye (range: 2-7). Median baseline visual acuity of 0.5 (95%-CI: 0.31-0.57) significantly deteriorated to 0.6 (95%-CI: 0.41-0.89, p=0.047). The median height of the PED did not change under the treatment (baseline 95%-CI: 349-675, final 95%-CI: 200-764, p=0.277). While the PED could not be resolved in any of the seven patients, conversion to fibrovascular PED was seen in one patient in spite of repeated bevacizumab injections.
As only very limited data is available for pure serous PED and its spontaneous course in the literature, comparative statements about the treatment efficacy cannot be drawn. However, even repeated series of bevacizumab injections could neither prevent a slow decrease in visual acuity nor improve the anatomic findings. Further studies should prospectively compare the outcome of vascularized PED with the more seldom, pure serous lesions to evaluate whether the response of anti-VEGF therapy is dependent on the presence of a supplying CNV.
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