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A. E. Hoeh, K. B. Schaal, A. Scheuerle, F. Schutt, S. Dithmar; OCT Guided Re-Injection of 2.5mg Bevacizumab for Treatment of Macular Edema Due to Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3453.
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To evaluate an OCT guided re-injection sceme of 2.5mg bevacizumab in patients with macular edema (ME) due to retinal vein occlusion.
Prospective study. After informed consent patients with persistent ME due to branch (BRVO) or central (CRVO) retinal vein occlusion receive intravitreal bevacizumab (2.5mg/0.1ml) every 6 to 8 weeks until ME resolves. Ophthalmic examination, visual acuity (ETDRS) and Stratus OCTTM are performed at baseline and every 6-8 weeks. Re-Injections are only performed if the OCT shows persistent or recurring ME.
78 patients (34 CRVO, 44 BRVO) have been included in the study so far with a mean follow-up of 31±21 weeks. In 43.6% (n=34) of patients ME had completely resolved 6 weeks after 1st injection (improvement in visual acuity 3.4±3.8 lines). 57.7% of these patients developed a relapse of ME within 13.3±4.4 weeks after first injection. In 42.3% of patients ME did not recur within 17.3±7.5 weeks. All patients with recurrence of ME received a 2nd injection that completely resolved ME within 6 weeks. Visual acuity gained the same level as after 1st injection (difference in visual acuity: 0.1±2.0 lines). Another relapse of ME in this group occurred in 69.2% of patients 13,1±5,7 weeks (6-25 weeks) after 2nd injection.Patients with persistent ME after 1st injection (56.4%; n=44) received a 2nd injection which led to complete ME resolution in 25%. All of these patients had a recurrence of ME after 13.8±4.1 weeks. In 75% of patients ME persisted after the 2nd injection and they were re-injected. Although no patient showed complete resolution of ME, there was a reduction of central retinal thickness during a follow up of 41.5±17.5 weeks and an average number of injections of 5.1±1.5 (3 to 8 injections). However there was no significant change in visual acuity in these patients.
OCT guided re-injections lead to anatomic and functional stabilisation or improvement even if transient recurrence of ME occurs and can minimize the number of injections needed in comparison to a re-injection scheme with fixed time intervals.Persistent ME after 1st injection may indicate a poor response to treatment with bevacizumab. Patients with persisting ME after two injections never showed a complete resolution of ME.
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