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E. Midena, E. Pilotto, R. Parrozzani, V. de Belvis, P. P. Radin, S. Vujosevic; Bevacizumab After Brachitherapy for Choroidal Malignant Melanoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5758.
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To report the effects of bevacizumab (a non-selective anti vascular endothelial growth factor drug) in the treatment of persistent serous retinal detachment after brachytherapy for choroidal melanoma.
Twenty eyes of twenty consecutive patients affected by persistent (> 6 months) or progressing serous retinal detachment after successful Iodine125 brachytherapy for medium/large choroidal melanoma underwent bevacizumab intravitreal injection (1.25mg in 0.05mL). Injection was repeated at 3 months interval if serous detachment persisted or progressed. Fundus photography, and A and B scan ultrasound were performed. OCT was performed when serous detachment involved the posterior pole. Four eyes had also iris neovascularization at baseline.
All tumors showed significant regression after brachytherapy (thickness: 5.8 ± 2.8 mm vs 4.1 ± 2.2 mm, p< 0.03). Mean follow-up after intravitreal injection was 9.2 ± 2.2 months. Serous detachment fully regressed in 18 of 20 (90%) bevacizumab treated eyes, with 1.5 mean number of injections. Iris neovascularization completely disappeared after one bevacizumab injection in 4 out of 4 eyes. No local or general complications were observed.
Persisting or progressing serous retinal detachment after brachytherapy for choroidal melanoma is a significant risk factor for severe visual loss and neovascular glaucoma. Vascular endothelial growth factor plays a major role in neoplastic and post-radiation serous retinal detachment. Intravitreal bevacizumab seems to be a promising approach in the treatment of these high-risk eyes.
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