Abstract
Purpose: :
To assess the safety and efficacy of intravitreal (IV) bevacizumab for the treatment of refractory uveitic cystoid macular edema (CME).
Methods: :
Retrospective, non-comparative case series of patients with refractory CME treated with 2.5-mg of IV bevacizumab . Clinical information including best-corrected Snellen visual acuity (VA), Intraocular pressure (IOP), optical coherence tomography (OCT) and fluorescein angiography (FA) results are reported.
Results: :
Ten patients (7 women and 3 men), with a mean age of 40 (range 24-61), underwent treatment with IV bevacizumab for refractory uveitic CME. The patients had uveitis with a variety of etiologies; six patients had idiopathic uveitis. Prior treatments included trans-septal or intravitreal kenalog in seven patients and immunomodulatory therapy in eight patients. All patients were on topical steroidal and non-steroidal anti-inflammatory medications without improvement of their symptoms. At the time of the injection none of the patients had active intraocular inflammation. Nine patients received one intravitreal injection of bevacizumab and one patient received two. The patients were followed for 1 to 3 months after injection. Improvement of one or more lines of VA (range 1-7 lines) was seen in 90% of the patients. In one patient the visual acuity remained unchanged after the first injection, but had worsened after the second injection. There were no complications related to the IV injection. There was no increase in the intraocular pressure or worsening of the intraocular inflammation in any of the eyes. OCT was performed pre- and post- injection in three eyes and showed a decrease in the central macular thickness (CMT) in two patients and temporary decrease in the CMT in one patient. Pre- and post- FA was performed in one patient and showed no improvement of the CME.
Conclusions: :
A majority of patients in this series showed improvement in VA and some showed decreased CMT on OCT after intravitreal bevacizumab injection. There were no adverse effects or complications associated with this treatment. A prospective randomized study is needed to prove the long-term efficacy of this medication.
Keywords: uvea • chorioretinitis • macula/fovea