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C. R. Prescott, C. A. Sklar, R. L. Lesser, R. A. Adelman; Is Intravitreal Bevacizumab an Effective Treatment Option for Nonarteritic Anterior Ischemic Optic Neuropathy?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):443.
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Nonarteritic anterior ischemic optic neuropathy (NAION) causes sudden, profound loss of vision with no known cause or cure. Various treatment modalities, both surgical (optic nerve sheath fenestration) and pharmacologic (intravitreal triamcinolone) have been tried without success. The purpose of our study was to evaluate the effect of intravitreal bevacizumab as a treatment option for NAION.
We performed a retrospective study of patients with NAION who were treated with intravitreal bevacizumab to determine the therapeutic effect. We studied demographics of patients, and compared pre and post injection visual acuity, pre and post injection optic nerve status, and pre and post injection visual fields.
Four patients met the inclusion criteria. The injections were performed between 1 day and 5 weeks after presentation. The patients’ age ranged from 40 to 69 and there were 3 men and 1 woman. The average pre-injection visual acuity was logMAR 0.2 (range logMAR 0.00-0.9), and the mean post injection visual acuity was also logMAR 0.2 (range logMAR 0.00-0.4). The only patient whose visual acuity increased was the patient who presented initially with the worst visual acuity. Visual fields progressed in 3 patients and remained stable in the one patient whose vision improved. Two of the patients presented with altitudinal defects and developed field loss in the other hemisphere. One patient presented with a quadrantopsia and developed a near complete macular sparing scotoma. All four patients presented with optic disc edema with associated flame shaped hemorrhages. The edema decreased in all four patients; all subsequently developed varying degrees of optic atrophy. Only 25% of the patients in our study improved by measure of VA and none improved by visual field.
Bevacizumab may not be an effective treatment option for NAION.
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