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H. M. Kwong, Jr., S. Danesh, M. Moin, B. Sell, M. D. Conway, G. A. Peyman; The Efficacy of Bevacizumab for Peripapillary Subretinal Neovascular Membranes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):323.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of intravitreal Bevacizumab for Peripapillary Subretinal Neovascular Membranes (SRNVM).
A retrospective analysis of 10 eyes of 8 patients with peripapillary SRNVM was done at a community based tertiary care retina practice between January 2006 and May 2007. Patients were seen at baseline, 4-6 weeks, 3 months and 6 months. Intravitreal bevacizumab 1.25 mg was administered within a week of presentation. Repeat injections were given at 1-2 monthly intervals, as indicated. Visual acuity, anterior and posterior segment examination, and intraocular pressure were done at each visit. Fluorescein Angiograms (IVFA) and Ocular Coherence Tomagraphy (OCT) were completed at each visit. All eyes with prior laser therapy, intravitreal injections or with SRNVM not emanating from the optic nerve head were excluded.
The average age of the 8 patients was 75 yrs - 3 males and 5 females. Three patients each had peripapillary SRNVM’s in the right or left eye, while two were bilateral. The average size of the lesion was 3.11 disc area (DA). Lesions were divided into 2 groups based on foveal involvement. Seven membranes extended to the fovea and 3 did not. The SRNVM’s were graded as small (1 DA), medium (2-3 DA) or large (4 or more DA). There were 2 small, 2 medium and 6 large membranes. Subretinal hemorrhages were present in all eyes while hard exudates were seen in only 2 eyes. The outcome measures were change in visual acuity and the resolution of leakage from the lesion on IVFA at 6 months. The 2 small lesions showed resolution of the leakage with 1 injection. The visual acuity remained at 20/30 for the eye without foveal involvement; the eye with foveal involvement improved from 20/200 to 20/80. One medium sized lesion showed resolution of leakage in 1 eye after 2 injections and improvement of visual acuity from 20/50 to 20/30; however, the other had persistent leakage after 2 injections but stabilized at 20/40. The 6 large lesions showed resolution of leakage in 4 membranes. The vision dropped 1 line in 2 eyes and improved 1 line in 2 eyes. The other 2 large lesions showed recurrence at 6 months follow-up after having receiving 3 or 4 injections. The vision dropped from 20/60 to 20/400 in one eye and 20/60 to 20/70 in the other eye. Subretinal hemorrhages resolved in all but 2 eyes.
The best response using mono therapy of intravitreal bevacizumab was seen in small sized lesions with little or no subfoveal involvement. Multiple treatments are required to stabilize the larger lesions. 33% of large lesions did not stabilize despite repeated injections.
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