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A. Shukairy, C. Patel, C. Singh, J. Puklin, T. Mahmoud; Correlation Between the Development of Shunt Vessels and Treatment Outcomes in Patients With Retinal Vein Occlusion Treated With Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5422.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the effect of intravitreal bevacizumab on the development of optociliary shunt vessels in patients with macular edema secondary to central (CRVO) and branch (BRVO) retinal vein occlusion, and evaluate the anatomic and functional outcomes in patients that developed shunt vessels versus those that did not.
A retrospective interventional study of patients treated with intravitreal bevacizumab for macular edema due to CRVO or BRVO was performed. Eyes with central subfield foveal thickness (CFT) measurements by optical coherence tomography (OCT) at 2 or more sessions were included. Fundus photographs at initial and all subsequent visits were examined for collateral shunt vessels. Patients were divided into 2 groups based on whether or not they developed shunt vessels.
Seventeen CRVO patients and 13 BRVO patients injected with bevacizumab at our institution met inclusion criteria. Nine CRVO patients (group 1A) developed shunt vessels, 55.6% prior to injection and 44.4% after injection, and 8 CRVO patients (group 1B) did not. In group 1A, mean CFT decreased from 567.4µm to 347.1µm (p=0.008), and mean BCVA improved from 20/400 to 20/100 (p=0.002). In group 1B, mean CFT slightly increased from 316.4 µm to 327.5 (p=0.9) and mean BCVA remained stable at 20/200 (p=0.23). Mean follow up was 14 and 21 months for groups 1A and 1B respectively. Nine BRVO patients (group 2A) developed shunt vessels, 77.8% prior to injection and 22.2% post-injection, and 4 BRVO patients (group 2B) did not. In group 2A, mean CFT decreased from 318.4µm to 266.6µm (p=0.42), and mean BCVA improved from 20/80 to 20/60 (p=0.52). In group 2B, mean CFT decreased from 423.5µm to 298.0 (p=0.47), and mean BCVA improved from 20/80 to 20/40 (p=0.64). Mean follow up was 22 months for group 2A and 19 months for group 2B.
Intravitreal bevacizumab did not prevent the subsequent development of optociliary shunt vessels in patients with retinal vein occlusion. CRVO eyes with shunt vessels had a significant improvement in both CFT and BCVA. There was no significant change in CFT or BCVA in eyes without shunt vessels. These results suggest that intravitreal bevacizumab does not inhibit the development of shunt vessels in retinal vein occlusion. Shunt vessels are correlated with significant improvements in anatomic and functional outcomes.
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