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K. K. Suk, M. Ober, U. Desai, P. Edwards; Intravitreal Bevacizumab (Avastin) in the Treatment of Macular Edema in Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2007;48(13):315.
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© ARVO (1962-2015); The Authors (2016-present)
To report the visual and anatomic results of intravitreal bevacizumab (Avastin, Genentech, South San Francisco, CA) for the treatment of macular edema (ME) associated with retinal vein occlusion (RVO).
A retrospective chart review was performed for patients with ME associated with RVO who received one or more injections of intravitreal bevacizumab (1.25 mg in 0.05 ml). Recorded were snellen visual acuity (VA) and central macular thickness (CMT) from optical coherence tomography (OCT) at time of injection and at subsequent follow up visits as well as the presence or absence of diabetes, hypertension, and any adverse side effects. Vision was converted to decimal VA for statistical analysis.
Twenty four eyes of 23 patients were included in the study, with 13 having central retinal vein occlusion (CRVO) and 11 with branch retinal vein occlusion (BRVO). Snellen VA was recorded for all eyes before and after treatment(s) and 21 of the 24 had macular thickness measured by OCT both prior to and after injection. The mean age at first treatment was 68 years. Seven patients had diabetes, 12 had hypertension and 5 had both. Seven eyes had been previously treated by other means. One patient received grid laser photocoagulation in conjunction with intravitreal bevacizumab for initial treatment. The baseline mean VA for all eyes was 0.197. Mean VA at first follow up, a mean of 29.8 days after injection, improved to 0.229, but was not statistically significant (p = 0.192). Baseline mean CMT in all eyes was 450.2 µm which improved to 315.1 µm at first follow up (p < 0.001). In eyes with BRVO, mean VA improved from 0.196 at baseline to 0.275 (p =0.040) at first follow up. Mean CMT improved from 447.8 µm at baseline to 282.3 µm (p = 0.004). In eyes with CRVO, however, mean VA decreased from 0.197 at baseline to 0.189 at first follow up, but was not statistically significant (p = 0.804). Mean CMT, meanwhile, decreased from 452.0 µm to 339.7 µm (p = 0.016). No adverse effects were noted.
Intravitreal bevacizumab for the treatment for ME from RVO showed significant improvement in CMT and a trend towards improved vision. Statistically significant improvement in both visual function and CMT was found for BRVOs. Whereas in CRVOs, there was a significant improvement in CMT but not in VA. Although limited in patient number and length of follow up, intravitreal bevacizumab appears to be a safe and effective treatment option for RVO, likely more so in BRVO than CRVO. A prospective randomized trial would be warranted to further study this new treatment.
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