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M. A. Leitritz, F. Gelisken, P. Szurman, F. Ziemssen, K. U. Bartz-Schmidt, G. B. Jaissle; Prospective Long-Term Follow up of Intravitreal Bevacizumab Therapy for Macular Edema Secondary to Branch Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2703.
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Intravitreal injection of the anti-VEGF drug bevacizumab (Avastin®) seems to be a promising therapy for edematous diseases. The aim of this study was to investigate the functional and morphological long-term effect of this treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO).
We evaluated the response to intravitreal bevacizumab (1.25mg/0.05ml) in a prospective interventional case series of 26 previously untreated patients with perfused ME. Duration of BRVO was 3 to 18 month and resorption of intraretinal hemorrhage in the foveal area was awaited. Complete ophthalmic examination including optical coherence tomography (OCT) was done every 6 weeks. The follow-up time was 24 weeks (24 eyes) and 48 weeks (12 eyes). Reinjection was considered at each follow-up visit depending on the individual course of the visual acuity and existence of ME on OCT.
At baseline median visual acuity (VA) was 0.49 logMAR and increased to 0.3 logMAR at 6 weeks (P<0.001, gain of 1.9 lines), and remained at a stable level at the follow-up visits. At the 48 weeks follow-up (12 eyes) a gain of 2.3 visual acuity lines was preserved. (P<0.001). Correspondingly, the median central retinal thickness (CRT) decreased by 34% and 53% at 24 and 48 weeks, respectively. However, the CRT showed an undulation course with a 12 weeks cycle reflecting recurrence of ME followed by reinjection. During the first six months of follow-up the mean number of re-injections was 1.6 (week 6 to 24). The need for reinjections decreased by more than 50% to a mean of 0.7 injections per patient during the following 6 months (week 30 to 48). Mean age was 68 years (range 45 to 80 years). Median time between symptoms of BRVO and first bevacizumab injection was 7.9 months (range, 3.0 to 16.6 months).
Our data indicate that bevacizumab has a positive long-term effect in the treatment of perfused ME secondary to BRVO. Both VA and macular thickness showed a remarkable recovery. Re-injections are necessary for stabilisation in most of the eyes. Further studies are necessary to evaluate whether permanent stabilisation can be obtained with this therapy.
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