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K. Chin, P. T. Finger; Anti-VEGF Bevacizumab (AvastinTM) for Radiation Retinopathy and Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5224.
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To evaluate intravitreal bevacizumab for radiation maculopathy and optic neuropathy.
After plaque radiation therapy, 9 patients developed posterior radiation vasculopathy (macular edema, hemorrhages, microangiopathy, neovascularization, and/or optic neuropathy). The mean patient age was 62.6 years (range 34-86), there were 3 males and 6 females. One patient had pre-existing diabetes mellitus and 3 hypertension. Choroidal melanomas were located 4 mm or less from either the fovea or optic disc. Intravitreal bevacizumab (1.25 mg in 0.05 cc) was periodically injected (every 6 to 8 weeks). Ophthalmic evaluations included best-corrected visual acuity (ETDRS), ophthalmic examination, fundus photography, fluorescein angiography and optical coherence tomography/ scanning laser ophthalmoscopy (OCT/SLO) imaging.
No bevacizumab-related ocular or systemic side effects have occurred within the first 8 months of therapy. The mean number of bevacizumab injections was 3.0 per patient (range 2-4), with a mean follow-up of 6 months (range 3-8) from the first bevacizumab injection. Progressive reductions in retinal hemorrhages, exudates, cotton wool spots, microangiopathy, optic neuropathy and macular edema were documented by fundus photography, angiography and OCT/SLO imaging. All patients with optic neuropathy exhibited regression of papilledema, hemorrhages and neovascularization. However, decreased macular and optic disk edema was the most consistent and reproducible finding. There were no cases of progression of radiation vasculopathy within our follow-up period. Improvement (n=4) or stabilization (n=5) of visual acuity was noted in all cases.
Radiation maculopathy and optic neuropathy are common sight-limiting complications that lead to blindness. This study suggests that intravitreal bevacizumab was well-tolerated and improved or maintained vision at a mean 6 month follow up. Evidence of reduced hemorrhage, decreased retinal and optic disk edema (angiographic leakage) suggests that more long-term studies of anti-VEGF therapy for radiation vasculopathy are warranted.
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