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A. Chiang, C. G. Bianciotto, J. Maguire, C. H. Park, J. A. Shields, C. L. Shields; Intravitreal Bevacizumab for Choroidal Neovascularization Associated With Choroidal Nevus. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4765.
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To report ten cases of occult choroidal neovascularization (CNV) associated with choroidal nevus managed with intravitreal bevacizumab.
Interventional case series. The patients underwent an ophthalmologic evaluation, including fluorescein angiography, B-scan ultrasonography, and optical coherence tomography (OCT). Clinical and imaging data were retrospectively analyzed to evaluate visual acuity outcomes and response to treatment both clinically and on retinal imaging.
Nine patients presented with CNV overlying a chronic choroidal nevus with a posterior margin within 1.5 mm of the fovea. In the tenth patient, the posterior margin of the nevus was located 10 mm from the fovea with extension of subretinal fluid into the macula. The CNV was subfoveal in 4 cases, juxtafoveal in 2 cases, and extrafoveal in 4 cases. Initial visual acuity was 20/20-20/50 in 5, 20/60-20/100 in 2, and 20/200 or worse in 3 cases. Clinical features included subfoveal fluid in 9, exudation in 5, and hemorrhage in 4 cases. Intravitreal bevacizumab (1.25 mg/0.05cc) was injected with regression of CNV in all ten cases using 2 to 24 injections (median 3 injections). In 2 eyes, following therapeutic response to bevacizumab later consolidation with photodynamic therapy (PDT) (juxtafoveal CNV) (n=1) or conventional laser (extrafoveal CNV) (n=1) was provided. Over mean follow up of 20 months, final visual acuity decreased by one line in 4 cases and improved by mean of 3 lines in 6 cases. There were no adverse effects from bevacizumab injections. All 10 choroidal nevi remained stable.
Intravitreal bevacizumab appears to be safe and effective for the management of CNV secondary to a choroidal nevus. In some cases, depending on the proximity of the CNV to the foveola, PDT or conventional laser may be useful for CNV consolidation.
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