Intravitreal Bevacizumab (Avastin) Treatment of Macular Edema in Central Retinal Vein Occlusion

Abstract

Purpose: : To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO).

Methods: : We conducted a retrospective study of patients with macular edema due to CRVO who were treated with at least one intravitreal injection of bevacizumab 1.25 mg in 0.05 ml. Patients underwent Snellen visual acuity testing, optical coherence tomography (OCT) imaging and ophthalmoscopic examination at baseline and follow–up visits.

Results: : There were 14 consecutive patients with a mean age of 76.2 years (standard deviation 10.1 years). Intravitreal triamcinolone had been previously administered to 9 patients, but all of these patients either had no improvement or had excessive intraocular pressure caused by the triamcinolone. The patients received a mean of 2 injections of bevacizumab. No adverse events were observed, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, retinal detachment or thromboembolic events in any patient. The mean central macular thickness at baseline was 840 microns and decreased to a mean of 371 microns at month 1 (p<.001). The mean baseline acuity was nearly 20/600 (logMAR = 1.47) and the mean acuity at month 1 was 20/200 (logMAR = 1), a difference that was highly significant (p=.001). Visual acuity improvement, defined as a halving of the visual angle, was seen in 9 of the 15 eyes. The mean intraocular pressure at baseline was 19 mm Hg and by month 1 the mean was 16.6 mm Hg.

Conclusions: : Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short–term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular edema and improvement in visual acuity at one month. The number of patients in this pilot study was limited and the follow–up is too short to make any specific treatment recommendations, but the favorable short–term results suggest further study is needed.

Keywords: vascular occlusion/vascular occlusive disease • macula/fovea • growth factors/growth factor receptors