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E. L. Thomas; Microdose Intravenous Bevacizumab for Treating Retinal Vascular Disease. Invest. Ophthalmol. Vis. Sci. 2007;48(13):289.
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To evaluate the use of microdose intravenous bevacizumab(BV) to treat retinal vascular disease.
A retrospective chart review of 34 patients having undergone intravenous injection of BV (1.25-2.50 mg) for the ocular complications of retinal vascular disease including anterior segment neovascularization, choroidal neovasularization (CNV) and diabetic macular edema (DME). Informed consent was obtained for intravenous injection and the risk benefit ratios were explained to each patient. The decision to use the intravenous route of administration of BV was made based on active bilateral disease, previous multiple intravitreous injection and decision to decline intravitreous (intraocular injection). Post-injection both eyes were evaluated by clinical examination, VA, and in some eyes fluorescein angiography and optical coherence tomography at multiple time points after injection. Three patients had 2 injections and one had 3. Fifteen eyes had CNV, 17 had DME, and 2 had other diseases.
More than 25% of the eyes responded by some improvement in at least one parameter VA, decrease invitreous hemorrhage, reduction in anterior segment neovascularization, reduction in choroidal neovascularization or a reduction in macular edema.
By previous clinical observation of fellow eye improvement in uniocular injection of BV, logical conclusion is that the drug has systemic distribution to the fellow eye despite very lose doses intraocularly. Extrapolating to low dose at intraocular dose levels (1.25-2.50 mg) systemic distribution after intravenous injection of BV can be demonstrated to have an ocular effect, sometimes bilaterally. Selected patients eyes in unique situations may benefit from systemic low dose BV when intraocular injection may be precluded or undesirable. Potential increase in intravenous dosage (10-20 mg) may be considered in the future with doses still well below the systemic doses used in cancer therapy (400mg/dose).
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