Original article
Clinical, Anatomic, and Electrophysiologic Evaluation Following Intravitreal Bevacizumab for Macular Edema in Retinal Vein Occlusion

https://doi.org/10.1016/j.ajo.2006.12.037Get rights and content

Purpose

To investigate clinical, anatomic, and electrophysiologic response after single intravitreal injection of bevacizumab for macular edema attributable to retinal vein occlusion.

Design

Prospective nonrandomized, interventional case series.

Methods

Twenty-one patients with macular edema attributable to vein occlusion received intravitreal injection of bevacizumab 1.25 mg. Nine patients had central retinal vein occlusion (CRVO), and 12 patients had branch retinal vein occlusion (BRVO). Complete ophthalmic examination including optical coherence tomography (OCT) was done at baseline and follow-up visits. Fifteen patients underwent fluorescein angiography at baseline. Selected patients underwent electroretinography (ERG) and visual evoked potential (VEP) at baseline and follow-up. Follow-up was for 12 weeks.

Results

At baseline, mean visual acuity was 20/381 (median, 20/400) and showed improvement to mean 20/135 (median, 20/60) after one month, (P = .001). At 12 weeks, mean visual acuity was 20/178 (median, 20/80) (P = .001). The mean central retinal thickness (CRT) was 647.81 μm (median, 609.00 μm) at baseline and decreased to mean 293.43 μm (median, 222.00 μm) at one month (P = .001). At 12 weeks, mean CRT was 320.90 μm (median, 280.00 μm) (P = .001). ERG and VEP showed no worsening of the waveforms. There was no significant difference in the visual outcome between the BRVO and CRVO groups.

Conclusion

Intravitreal injection of bevacizumab appears to result in significant short-term improvement of visual acuity and macular edema secondary to vein occlusion. The present report confirms the previous studies. No ocular toxicity or adverse effects were observed. However, prospective, randomized, controlled long-term studies are required with an adequate number of patients.

Section snippets

Methods

We conducted a nonrandomized, prospective study after approval of the Institutional Ethical Committee, and all patients signed an informed consent to participate in the study. This study has been registered with www.clinicaltrials.gov, and the registration information is available to the public through the Web site http://www.clinicaltrials.gov/, registration number NCT00403026. Twenty-one eyes of 21 consecutive patients with macular edema attributable to vein occlusion with vision less than

Results

A total of 21 eyes of 21 patients were analyzed. Eleven patients (52.4%) were male, and 10 were (47.6%) female. The mean age was 66.7 ± 8.5 years (range, 42 to 78 years). Nine patients had central CRVO, and 12 patients had BRVO. Fourteen patients were hypertensive, three were diabetic, two patients were both diabetic and hypertensive, and in two patients, no cause was found. All patients had cystoid macular edema (CME) on OCT imaging with BCVA of 20/80 or less. None of the patients had

Discussion

Use of bevacizumab in the treatment of various retinal disorders is increasingly being reported.8, 14, 15, 16, 17

Central retinal vein occlusions are associated with varying amounts of retinal ischemia and consequently increased concentrations of VEGF.13 Rosenfeld and associates were the first to report the efficacy and OCT changes following intravitreal injection of bevacizumab for recurrent macular edema secondary to CRVO in an eye previously treated by intravitreal triamcinolone acetonide

Sivakami A. Pai, MS, DNB, started her medical training at Government Medical College, Bellary, South India. She did her post-Graduation in Ophthalmology at Regional Institute of Ophthalmology, Minto Ophthalmic Hospital (RIO-MOH), Bangalore Medical College in 1998. Dr Pai obtained her DNB in Ophthalmology at New Delhi University. Dr Pai did her post-Doctoral Fellowship in Vitreo-Retina at RIO-MOH affiliated to Rajiv Gandhi University of Health Sciences. Her areas of interest includes surgical

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Sivakami A. Pai, MS, DNB, started her medical training at Government Medical College, Bellary, South India. She did her post-Graduation in Ophthalmology at Regional Institute of Ophthalmology, Minto Ophthalmic Hospital (RIO-MOH), Bangalore Medical College in 1998. Dr Pai obtained her DNB in Ophthalmology at New Delhi University. Dr Pai did her post-Doctoral Fellowship in Vitreo-Retina at RIO-MOH affiliated to Rajiv Gandhi University of Health Sciences. Her areas of interest includes surgical retina, AMD, retinal vascular disorders, ROP, and HIV.

Rohit Shetty, DNB, FRCS (Glasg), is presently a Director of Cornea and Refractive Surgery and Head of Electrophysiology and Neuro-ophthalmology at Narayana Nethralaya, Bangalore, India. He did his postgraduate training from St John’s National Academy of Medical Sciences, Bangalore, India. Dr Shetty has completed the Fellowship examination of the Royal College of Surgeons, (FRCS, Glasgow). His special areas of interests include Lasik, Keratoconus Management, and Multifocal ERG.

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