K. B. Schaal

Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy

Purpose To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to chronic central serous chorioretinopathy (CSC). Methods Twelve patients were treated with intravitreal injections of 2.5 mg bevacizumab at 6-to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses. Results Patients received 2±1 intravitreal injections of bevacizumab on average during a follow-up of 24±14 weeks. Mean BCVA increased by 2±2 lines; the change in BCVA (log-MAR) was significant (p<0.02). Mean central retinal thickness decreased significantly over follow-up (p<0.05), with 6 patients (50%) showing complete resolution of subretinal fluid. Conclusions Anatomic and functional improvement following intravitreal bevacizumab injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSC. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSC. Further evaluation of intravitreal bevacizumab for chronic CSC in controlled randomized studies is warranted.

Intravitreal bevacizumab for retinal capillary haemangioma: longterm results

Editor, V on Hippel)Lindau (VHL) disease is attended by multisystemic manifestations in many cases, but the central nervous system and retina are the most frequent locations of symptoms. Treatment of retinal capillary haemangioma caused by VHL disease can be a challenge and different approaches, such as laser photocoagulation, cryotherapy, photodynamic therapy, transpupillary thermotherapy and radiotherapy, have been tried with variable degrees of success (Garcia-Arumı́ et al. 2000). The VHL gene on chromosome 3, normally expressed in healthy people, is absent in VHL patients. This leads to an increase in the expression of vascular endothelial growth factor (VEGF) (Chan et al. 1999). Systemic anti-VEGF treatment has been reported in single cases, but this can be associated with severe side-effects (von Buelow et al. 2007). The longterm efficacy of intravitreal antiVEGF treatment has not yet been described for this disease. We report the outcome of intravitreal bevacizumab for retinal capillary haemangioma administered over a period of 2 years in a patient naı̈ve to this medication. A 40-year-old woman with VHL disease presented with a new retinal capillary haemangioma in the midperiphery in the left eye. Growth pattern was sessile with associated lipid exudation (Fig. 1A). Thirteen years earlier, a juxtapapillary haemangioma in the same eye had been treated with laser coagulation, resulting in scarred tissue and visual acuity (VA) of 20 ⁄ 400 (Fig. 1B). As a result of this experience, the patient refused further destructive procedures. After detailed discussion, intravitreal bevacizumab was offered as an off-label treatment option. The patient also suffered from several haemangiomas in the kidney, brain and right eye, the last of which had been treated with laser coagulation (VA 20 ⁄ 63). The patient did not receive any systemic treatment for VHL disease. When the patient had provided informed consent, a total of nine injections (administered every 13–14 weeks) of 2.5 mg bevacizumab were given intravitreally in the left eye over a period of 26 months. No adverse events attributable to intravitreal injections were observed and VA remained stable. The retinal capillary haemangioma did not grow significantly, whereas haemangiomas in other locations continued to grow and a new peripheral haemangioma appeared in the right, but not in the left, eye. The lipid exudation resolved almost completely and the feeder vessels did not enlarge (Fig. 1C). The new peripheral haemangioma in the fellow eye was treated with laser coagulation. Therapeutic strategies for retinal haemangiomas associated with VHL disease vary and often lead to unsatisfactory results, especially in centrally located haemangioma (Garcia-Arumı́ et al. 2000). Therefore, the increased intravitreal level of VEGF in VHL patients may represent a new target in effective therapy of retinal capillary haemangioma. In order to avoid an ongoing proliferation of retinal haemangioma caused by high VEGF expression, we administrated the VEGF antibody bevacizumab intravitreally. Injections were given every 13–14 weeks on the basis of our observations in patients with retinal vein occlusions. A dosage of 2.5 mg bevacizumab proved effective in the treatment of macular oedema for an average of 13 weeks. Over a period of > 2 years of treatment, the retinal haemangioma did not grow significantly and lipid exudation resolved completely. Dahr et al. (2007) presented similar results in their patients, but their observation time was only 1 year and this was marked by some adverse events. Here, no side-effects were reported, a finding in line with earlier reports on the safety of intravitreal bevacizumab (Fang et al. 2008). Anti-VEGF treatment reduces the permeability of retinal haemangiomas, which has also been observed after systemic administration of VEGF (A) (B)

Internal drainage in optic pit maculopathy

Optic disc pit with associated serous macular detachment has a poor visual prognosis if left to its natural course. It has been suspected that the subretinal fluid originates from the vitreous cavity via an inner retinoschisis-like separation within the papillomacular bundle between the optic disc pit and the central retinal detachment.1 We report a surgical approach on the basis of this assumed pathomechanism. A 20-year-old man presented with decreased vision in OD (right eye) due to macular detachment in association with an optic nerve pit (fig 1). Visual acuity was 20/400 OD and 20/20 OS (left eye). Optical coherence tomography revealed parapapillar retinoschisis-like separation of the outer retinal layers and …

Treatment of peripapillary choroidal neovascularization with intravitreal bevacizumab.

Purpose Peripapillary choroidal neovascularization (CNV) is an uncommon condition and often shows a growth tendency towards the fovea during spontaneous progression that threatens visual acuity. Treatment of peripapillary CNV is difficult. The authors report results of intravitreal bevacizumab therapy for peripapillary CNV. Methods Four patients with CNV located in the temporal or superior peripapillary area received intravitreal bevacizumab injections. Ophthalmologic examinations including OCT were performed at baseline and at 6-week intervals. Fluorescein angiography was performed at baseline and depending on clinical and OCT findings. The mean follow-up was 34±20 (22–69) weeks. Results The patients received an average of 3.5±3.1 (1–8) injections. In all patients fluorescein angiography showed inactivation of peripapillary CNV. No further increase in size was observed in any of the patients. The OCT showed a decrease of intraretinal and subretinal fluid. No intraocular or systemic side effects were observed. Conclusions In this series of patients, intravitreal bevacizumab appears to be efficacious. A progression of peripapillary CNV could be prevented in all patients and the lesion was successfully inactivated. Anti-VEGF treatment with bevacizumab represents a promising therapy option for peripapillary CNV.