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Intravitreal bevacizumab treatment of macular oedema due to central retinal vein occlusion

2006; Wiley; Volume: 84; Issue: 4 Linguagem: Inglês

10.1111/j.1600-0420.2006.00740.x

1600-0420

Ulrich Spandau, Anna K. Ihloff, Jost B. Jonas,

Vascular Malformations Diagnosis and Treatment

Acta Ophthalmologica ScandinavicaVolume 84, Issue 4 p. 555-556 Free Access Intravitreal bevacizumab treatment of macular oedema due to central retinal vein occlusion Ulrich H. M. Spandau, Ulrich H. M. Spandau Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this authorAnna K. Ihloff, Anna K. Ihloff Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this authorJost B. Jonas, Jost B. Jonas Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this author Ulrich H. M. Spandau, Ulrich H. M. Spandau Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this authorAnna K. Ihloff, Anna K. Ihloff Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this authorJost B. Jonas, Jost B. Jonas Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, GermanySearch for more papers by this author First published: 20 July 2006 https://doi.org/10.1111/j.1600-0420.2006.00740.xCitations: 49 Dr U.H.M. SpandauUniversitäts-AugenklinikTheodor-Kutzer-Ufer 1–368167 MannheimGermanyTel: + 49 621 383 2242/2652Fax: + 49 621 383 3803Email: Ulrich.Spandau@augen.ma.uni-heidelberg.de AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Editor, A 68-year-old man presented with sudden loss of visual acuity (VA) to 20/200 OD. Ophthalmoscopy revealed multiple intraretinal haemorrhages, dilated and tortuous retinal veins, macular oedema and optic disc oedema. The ocular findings were consistent with a non-ischaemic central retinal vein occlusion (CRVO). Optical coherence tomography (OCT) demonstrated extensive submacular fluid and an elevation of macular thickness to 662 µm (Fig. 1). Visual acuity and ophthalmoscopy of the left eye were unremarkable. Figure 1Open in figure viewerPowerPoint Optical coherence tomography of the macula demonstrating extensive subretinal fluid prior to an intravitreal injection of 1.5 mg bevacizumab. The retinal thickness map shows a central elevation of the macula to 662 µm. Visual acuity was 20/200. An intravitreal off-label bevacizumab injection was recommended. The patient was fully informed about the experimental nature of the treatment and signed an informed consent. The operation was performed in the sterile setting of an operation room. The intravitreal dosage of bevacizumab was 1.5 mg in 0.3 ml Ringer's solution. On post-injection day 3, OCT showed extensive reduction in the submacular fluid and residual swelling of the macula to 314 µm. An OCT performed on post-injection day 10 demonstrated a further decrease in macular thickness to 269 µm. Visual acuity increased to 20/40. At the final follow-up examination 8 weeks after the injection, VA was 20/25 and macular thickness had reduced further to 217 µm (Fig. 2). Figure 2Open in figure viewerPowerPoint Optical coherence tomography of the macula revealing resolution of subretinal fluid and restoration of macular anatomy at 2 months after an intravitreal injection of 1.5 mg bevacizumab. The retinal thickness map indicates a central thickness of 217 µm. Visual acuity was 20/25. Central retinal vein occlusions are associated with varying amounts of retinal ischaemia and consequently increased concentrations of vascular endothelial growth factor (Hayreh 1983). Early case reports on bevacizumab by Rosenfeld et al. (2005a, 2005b) showed an increase in VA and decrease in macular oedema secondary to exudative AMD and CRVO. A non-randomized study of intravitreal bevacizumab in patients with CRVO resulted in reduced macular swelling and increased VA (Iturralde et al. 2006). The present report confirms the previous investigation and suggests that intravitreal bevacizumab may reduce macular oedema and increase VA in CRVO. The advantages of intravitreal bevacizumab compared with intravitreal triamcinolone acetonide are the lack of increase in intraocular pressure and absence of cataract formation. However, because a physiological level of vascular endothelial growth factor may be necessary for the homeostasis of the retina, care may have to be taken to avoid the possible negative consequences of a complete blockade of vascular endothelial growth factor, particularly in primarily ischaemic diseases. References Hayreh SS (1983): Classification of central retinal vein occlusion. Ophthalmology 83: 458– 474. CrossrefGoogle Scholar Iturralde D, Spaide RF, Meyerle CB et al. (2006): Intravitreal bevacizumab (avastin) treatment of macular oedema in central retinal vein occlusion: a short-term study. Retina 26: 279– 284. CrossrefPubMedWeb of Science®Google Scholar Rosenfeld PJ, Fung AE & Puliafito CA (2005a): Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular oedema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 36: 336– 339. PubMedWeb of Science®Google Scholar Rosenfeld PJ, Moshfeghi AA & Puliafito CA (2005b): Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging 36: 331– 335. CASGoogle Scholar Citing Literature Volume84, Issue4August 2006Pages 555-556 FiguresReferencesRelatedInformation