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R. G. Josephberg, D. M. Esposito; The Holy Grail Treatment for Pars Planitis. What Are the Options? Cryopexy, Steriods, Immunosuppressives, Immunomodulators, Lasers, Anti-Angiogenics, or Observation?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5873.
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To find a logical and curative treatment for pars planitis that would have minimal side effects and costs with a long-term response.Prior studies have shown that all patients with snowbanking have either clinical or subclinical neovascularization and that an average of 2-3 cryopexy treatments leads to destruction of these vessels with clinical improvement in the uveitis.However, this is a destructive and painful procedure.To decrease the number of cryopexy treatments needed, we propose using Avastin, an agent with anti-inflammatory properties, as an adjunctive treatment for pars planitis.
A retrospective study of 4 patients diagnosed with pars planitis, and subclinical neovascularization of the snowbanks on fluorescein angiography(IVFA).All patients were responsive to treatment with systemic steroids but suffered from systemic side effects.Several patients had adjunct periocular steroids, however none were treated with immunosuppressives.All patients were off steroids when diagnosed with a reactivation of pars planitis.A baseline IVFA was performed and all patients had neovascularization in the snowbanks documented with scleral depression and IVFA simultaneously.All patients were injected with intravitreal Avastin 1.25 MG.Follow-up included a complete ophthalmic examination and repeat IVFA.
All 4 patients injected with Avastin had an immediate and dramatic response not requiring a repeat injection.Follow-up exams showed progressively less inflammation, but repeat IVFA showed continued leakage.Since all patients with pars planitis have neovascularization in the snowbanks, contributing to this leakage, Avastin along with cryopexy may be a remarkable treatment for pars planitis.This combination may be a better regimen than some of the harmful medical treatments available and could be the treatment of choice; patients may require fewer painful cryopexy procedures and may experience less detrimental side-effects than when treated with long-term systemic steroids, immunosuppressives or immunomodulators.
Although not used to treat cystoid macular edema, Avastin was highly effective in decreasing the amount of clinical inflammation in all our patients.The results over 4 months were dramatic with few side-effects.Further studies are needed to show the long-term effects of this regimen.Since all snowbanks have new leaky blood vessels, we propose cryopexy and Avastin in combination is the Holy Grail treatment for pars planitis.
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