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P. T. Finger; Experience With Avastin (Bevacizumab) for Radiation Maculopathy and Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5149.
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To report on the use of intravitreal anti-VEGF bevacizumab for radiation optic neuropathy (RON) and radiation maculopathy (RM).
In this prospective, non-randomized, single center interventional clinical case series, 49 patients treated with plaque radiation therapy (for choroidal melanoma) developed either macular radiation retinopathy (edema, hemorrhages, capillary dropout, and/or intraretinal microangiopathy including neovascularization) or anterior radiation optic neuropathy (optic disc edema, hemorrhages, microangiopathy, neovascularization). Entry criteria included a subjective or objective loss of vision. Treatment involved intravitreal injection of bevacizumab (Avastin, Genentech, South San Francisco, CA) 1.25 mg in 0.05 mL every 6 to 8 weeks. Treatment was discontinued if there was no measurable response to therapy. The main outcome measures included safety, visual acuity, and clinical findings on OCT/SLO imaging, fundus photography and angiography.
In this series, there were 30 females and 19 males with a mean age of 65 years (range 34-89). In treatment of RON, patients were followed for a mean of 26 months (range 1-42) and received a mean of 10 intravitreal injections (range 1-22). Visual acuities were stable or improved in 63% (n=10), and 19% (n=3) have regained 2 or more lines of vision. In treatment of RM, patients were followed for a mean 22 months (range 1-45) and received a mean of 9 intravitreal injections (range 1-21). Visual acuities were stable or improved in 81% (n=30), and 16% (n=6) regained 2 or more lines of best-corrected visual acuity. Intraocular bevacizumab treatment was found to reduce retinal hemorrhage, exudation and edema. Reductions optic disc hemorrhage and edema were also noted. The most common and reproducible findings were decreased edema, restoration of the normal anatomy of the macula and optic nerve with improvement in vision. No ocular or systemic bevacizumab-related side effects were observed up to 45 months of treatment.
Intravitreal bevacizumab was well-tolerated and stabilized or improved vision in most cases. Treatment was associated with decreased vascular leakage as evidenced by reductions in retinal hemorrhage, exudates, and retinal edema/papilledema. This study suggests that an anti-VEGF strategy may reduce tissue damage associated with RM and RON.
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