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C. A. E. Eenhorst, J. P. Martinez, T. Missotten; The Use of Bevacizumab in Therapy Resistant CSC/DRPE With or Without Cnv. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1344.
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To study the effect of Bevacizumab (Avastin) injections on therapy-resistant subretinal and intraretinal fluid in Diffuse Retinal Pigment Epitheliopathy (DRPE) or chronic Central Serous Chorioretinopathy (CSC). A particular subgroup are patients in which DRPE is complicated by choroidal neovascularization (CNV).
Retrospective case series.Therapeutic response (visual acuity- BCVA) and optical coherence tomography (OCT) was studied before and after multiple Avastin intravitreous (0.05cc) injections.
A median of 4 3 injections were used in 9 patients with chronic CSC/DRPE with persistant subretinal fluid and in 5 patients with chronic CSC/DRPE complicated with CNV.In the group without CNV BCVA ameliorated from 0.26 to 0.36 (Snellen) (p>0.05). In the group with CNV BCVA ameliorated from 0.33 to 0.42 ( Snellen) (p>0.05).OCT in the group without CNV showed diappearance of any fluid in 3 out of 9 patients after a single injection. In another 3 patients fluid on OCT disappeared after a several injections.In the group with CNV fluid disappeared immediately after the first injection in 1 out of 5 patients. Another patient acquired a normal OCT after multiple injections.
In patients with chronic CSC/DRPE with persistant fluid retention, resistant to conservative therapy (PDT, laser), Avastin injections do not significantly influence BCVA, not withstanding a substantial improvement in OCT appearance. This is propalby due to the fact that longstanding fluid accumulation and macular damage had already occurred when this off-label therapy was used. Our findings suggest CNV complicating CSC/DRPE responds poorly to Avastin injections compared to age related macular degeneration or other types of CNV. In therapy resistant CSC/DRPE without CNV, a trial of Avastin injections could be beneficial in an earlier stage of the disease.
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