Abstract
Purpose: :
The purpose of this study is to report the novel use of an anti–angiogenic agent, bevacizumab (Avastin), as a surgical adjuvant in the treatment of traction retinal detachment secondary to retinal neovascular proliferation associated with central retinal vein occlusion. Pre–operative and post–operative flourescein angiography as well as immunohistocytochemistry and ultrastructural analysis are presented.
Methods: :
This is a case report of a 45 year old female who sustained a central retinal vein occlusion 2 months prior to presentation associated with neovascular proliferation at the optic disc as well as retinal neovascular proliferation as demonstrated on flourescein angiography. A complete traction retinal detachment was noted as well consistent with hand–motion visual acuity. After obtaining informed consent, the patient was given an intravitreal injection of bevacizumab 0.05cc into the affected eye in order to decrease intraoperative bleeding during retinal re–attachment surgery. The patient underwent retinal detachment surgery one month post–injection.
Results: :
At week two post–injection, a marked decrease in neovascularization was noted both around the optic nerve as well as in other areas of the retina as demonstrated with repeated flourescein angiography. Histopathology revealed pre–retinal membranes with neovascular channels, highlighted by a CD34 immunohistochemical stain. Ultrastructural analysis with electron microscopy revealed a collagen matrix with few smooth muscle cells and capillaries with non–specific degenerative changes.
Conclusions: :
Intravitreal bevacizumab may be a useful adjuvant pre–operatively to reduce neovascularization in order to decrease intra–operative bleeding complications in patients with retinal detachment and neovascularization.
Keywords: neovascularization • retinal detachment • vitreoretinal surgery