Alper Sengul

Intravitreal Bevacizumab in Treatment of Idiopathic Persistent Central Serous Chorioretinopathy: A Prospective, Controlled Clinical Study

Purpose: To evaluate and determine the effect of intravitreal bevacizumab in treatment of persistent central serous chorioretinopathy. Methods: This prospective, comparative clinical study included 30 eyes of 30 patients with persistent, symptomatic central serous chorioretinopathy of 3 months’ duration or more. Fifteen eyes of 15 patients were treated with intravitreal injections of 2.5 mg (0.1 ml) bevacizumab (treatment group). Fifteen eyes of 15 patients with the same characteristics who declined treatment were an acceptable control group. The visual and anatomic responses were observed with best-corrected visual acuity and central foveal thickness measured by optic coherence tomography at baseline,1, 3, and 6 months after treatment. Results: Twelve (80%) eyes in the treatment group compared with 8 (53.3%) eyes in the control group showed morphologic restitution at 6 months (P < 0.01). All 15 (100%) treated eyes had stable or improved vision, compared with 10 (66.6%) eyes in the control group (P < 0.01). At 6 months, the mean ± SD central foveal thickness for the treatment group remained significantly lower compared to the control group, with 174 ± 68 µm and 297 ± 172 µm, respectively (P < 0.001). Injection-related complications were not encountered. Conclusions: Our results indicate that intravitreal bevacizumab injection may be a new, promising treatment option for select patients with idiopathic persistent central serous chorioretinopathy. Continued studies with intravitreal bevacizumab in this population will help to establish its long-term efficacy.

Intravitreal Bevacizumab (Avastin) Injection in Retinitis Pigmentosa

Purpose: To evaluate and report the effectiveness, visual, anatomical, and clinical outcome of intravitreal bevacizumab (Avastin) injection in patients with retinitis pigmentosa (RP). Methods: Our prospective study included 13 eyes of 7 patients (4 women and 3 men) in the age range of 25–69 years (mean 44.14 years) with cystoid macular edema (CME) secondary to RP. Intravitreal bevacizumab at a dose of 1.25 mg/0.05 ml was injected via a 28-gauge needle. The response rate to treatment was monitored functionally by visual acuity assessment and anatomically using the optical coherence tomography. Results: The baseline mean central macular thickness was 370.15 μ m (range 245–603 μ m. The central macular thickness decreased to 142.53 μ m (range 124–168 μ m) after bevacizumab injections. The pre- and post-treatment visual acuity ranges were 5/400–20/100 and 20/200–20/63, respectively. Conclusions: Our data reveal that intravitreal bevacizumab administration is effective for the treatment of CME in RP. Further studies with a larger population and longer follow-up period are warranted to assess the efficacy of the treatment.

Intravitreal Ranibizumab in the Treatment of Cystoid Macular Edema Associated With Retinitis Pigmentosa

PURPOSE To report and evaluate the anatomic, clinical, and visual acuity response after intravitreal ranibizumab (IVR) injection in patients with cystoid macular edema (CME) due to retinitis pigmentosa (RP). METHODS This study included 30 eyes of 30 patients with RP who had persistent CME at least 6 months despite medication with acetazolamide. Fifteen eyes of 15 eligible patients were treated with 0.5 mg IVR injection (treatment group). Fifteen eyes of 15 patients with the same characteristics who refused treatment were accepted as control group. The primary outcome of the study (morphologic restitution) was the complete or significant resolution of cystoid space on optic coherence tomography (OCT) without relapse or complication at 6 months. The serial changes in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured. RESULTS Thirteen eyes (86.6%) in the treatment group had significant resolution of CME at 6 months after single IVR injection. The difference between the 2 groups in BCVA was not statistically significant (P > 0.05). The baseline mean +/- SD CFT for the treatment and control groups were 478 +/- 88 microm and 469 +/- 75 microm, respectively (P > 0.05). At 6 months after treatment, the mean +/- SD CFT of the treatment group improved to 272 +/- 65 microm whereas that in the control group was 480 +/- 92 microm (P < 0.001). CONCLUSIONS This investigation indicated that IVR may provide a new therapeutic approach for the treatment of CME secondary to RP. No adverse event was found to be associated with the treatment. Continued experience with IVR in this population will help establish its longer-term efficacy.

Posterior Reversible Encephalopathy Syndrome After Intravitreal Bevacizumab Injection in Patient with Choroidal Neovascular Membrane Secondary to Age-Related Maculopathy

The posterior reversible encephalopathy syndrome (PRES), a complex of cerebral disorders including headache, seizures, visual disturbances, is associated with a variety of conditions in which blood pressure rises acutely. Arterial hypertension can occur in systemic administration of bevacizumab. A few cases of systemic injection of bevazicumab-induced PRES have been reported. In this article, we first report on a patient who developed PRES following intravitreal bevazicumab.

Simultaneous Intravitreal and Intracameral Injection of Bevacizumab (Avastin) in Neovascular Glaucoma

PURPOSE To report the effects of simultaneous intravitreal and intracameral injection of 1.25 mg bevacizumab (Avastin) in 15 neovascular glaucoma (NVG) cases secondary to iris and/or angle neovascularization. PATIENTS AND METHODS The study included 15 eyes of 15 patients (seven women, eight men) with NVG secondary to central retinal vein occlusions (CRVO) or proliferative diabetic retinopathy (PDR). Eight eyes had had CRVO and seven PDR prior to NVG. The severity of neovascularization and peripheric anterior synechiae (PAS) was scored from mild (+) to severe (+++). A total dose of 1.25 mg bevacizumab in 0.05 mL was injected into the vitreous cavity and the same dose of bevacizumab into anterior chamber by sterile 30-gauge needle. RESULTS After treatment neovascularizations on iris and angle were completely resolved 36 h after injection in all patients. Intraocular pressure (IOP) was decreased under 22 mmHg in six cases without any medication. Six cases need medical treatment to achieve appropriate IOP level. Surgical procedure was necessary in three patients who persist high IOP levels despite completely resolved neovascularizations. CONCLUSIONS Simultaneous intravitreal and intracameral injection of bevacizumab can cause an immediate regression of neovascularization secondary to PDR or CRVO and could be an useful adjuvant to prevent dense PAS formation that lead to persistent IOP increasing.

Combination treatment with intravitreal injection of ranibizumab and reduced fluence photodynamic therapy for choroidal neovascularization secondary to angioid streaks: preliminary clinical results of 12-month follow-up.

Background: To evaluate combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks. Methods: This is an interventional case series of 10 previously untreated eyes of 10 patients with choroidal neovascularization secondary to angioid streaks. All eyes were treated with reduced fluence photodynamic therapy using 25 J/cm2, immediately followed by intravitreal ranibizumab injection at baseline, and subsequent injections were performed on an as-needed basis thereafter. Treatment efficacy was assessed based on best-corrected visual acuity and optical coherence tomography findings. Results: After 12 months of follow-up, the best-corrected visual acuity improved by >2 lines in 6 eyes (60%), remained within 2 lines of baseline in 3 eyes (30%), and decreased by ≥3 lines in only 1 eye (10%). The mean central foveal thickness decreased significantly from 332.2 μm at baseline to 235.7 μm at the last follow-up (P < 0.001), as measured by optical coherence tomography. Conclusion: The preliminary results of this prospective study indicate that combination treatment with intravitreal ranibizumab injection and reduced fluence photodynamic therapy for choroidal neovascularization associated with angioid streaks seems to be effective in reducing or eliminating retinal edema, regression of neovascularization, and improving or stabilizing visual acuity without any complications. Large controlled studies are needed to evaluate the long-term effects of this combination regimen.

Central serous chorioretinopathy associated with topical latanoprost therapy.

Purpose: To report a case of central serous chorioretinopathy (CSC) as a possible complication of latanoprost treatment. Methods: A 65-year-old woman presented with a 1-week history of blurred vision and metamorphopsia in her right eye. She was previously diagnosed with unilateral glaucoma, and treatment was initiated with topical latanoprost 0.005% for the right eye. The symptoms occurred 1 month after initiation of glaucoma treatment. Results: Visual acuity (VA) of the patient had reduced to 20/50 in right eye. Fluorescein angiography revealed a focal RPE leak near to the fovea with neurosensory detachment due to CSC, which was confirmed by optical coherence tomography. After cessation of the therapy, her clinical and morphological status improved spontaneously. The neurosensory detachment resolved almost completely and VA improved to 20/20 simultaneously. Conclusions: The authors report the first case of CSC associated with latonoprost therapy. This case demonstrates that topical latanoprost may lead to the development of CSC.

Bimatoprost 0.03% Versus Brimonidine 0.2% in the Prevention of Intraocular Pressure Spike Following Neodymium:Yttrium–Aluminum–Garnet Laser Posterior Capsulotomy

PURPOSE The aim of this study was to compare the efficacy of bimatoprost 0.03% with brimonidine 0.2% in preventing intraocular pressure (IOP) elevations after neodymium:yttrium–aluminum–garnet (Nd:YAG) laser posterior capsulotomy. METHODS In this prospective, randomized, double-masked study, 195 eyes of 195 consecutive patients who had YAG laser capsulotomy for posterior capsule opacification were recruited. Eyes received either 1 drop of bimatoprost 0.03% (98 patients) or brimonidine 0.2% (97 patients) at 1h before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1h, 3h, 24h, and 7 days. Inflammation was evaluated after surgery. Formation of cystoid macular edema was assessed by measuring the macular thickness before and after laser surgery. RESULTS The average peak of postoperative IOP elevation was 2.2±3.9mm Hg in the bimatoprost 0.03% and 3.6±3.1mm Hg in the brimonidine 0.2% group. The difference was statistically significant (P<0.001). Postoperative IOP elevations of 10mm Hg or more occurred in 1 eye (1.56%) in the bimatoprost 0.03% group and 5 eyes (7.35%) in the brimonidine 0.2%. This difference was statistically significant (P<0.001). Macular edema and anterior chamber reaction were not observed related to bimatoprost. No clinically significant side effects were noted in either group. CONCLUSIONS Our results indicate that prophylactic use of bimatoprost 0.03% is more effective than brimonidine 0.2% in preventing IOP elevation immediately after YAG laser capsulotomy. Bimatoprost 0.03% as a prostamide analog may provide new option for preventing IOP elevation after YAG laser capsulotomy.

Acute retinal arterial occlusion after intravenous administration of bevacizumab.

Retinal artery occlusions are usually the result of emboli, although non-embolic causes such as vasculitides, coagulopathies, and vasospasms resulting from migraines and inflammatory conditions do occur. Bevacizumab, a humanised monoclonal antibody, is designed to bind to and inhibit vascular endothelial growth factor (VEGF). VEGF is a protein that plays a critical role in tumour angiogenesis, the formation of new blood vessels to the tumour. The use of bevacizumab has spread worldwide, but the drug related adverse events associated with its use have been reported in a few retrospective reviews. We report on a previously unpublished case of retinal artery occlusion following the use of systemic bevacizumab.

Central serous chorioretinopathy in Susac syndrome.

We report central serous chorioretinopathy (CSC) in a patient with Susac syndrome. The diagnosis of Susac syndrome was based on the results of funduscopy, brain magnetic resonance imaging, and audiometric testing. Our case demonstrates that possible choroidal involvement in Susac syndrome may lead to the development of CSC.