Early Avastin management in acute retinal vein occlusion

Abstract

Purpose To evaluate the safety, functional and anatomical effects of intravitreal Avastin (bevacizumab) in treatment of recent retinal venous occlusion. Design Prospective interventional series non-comparative study. Setting Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt. Methods The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3 months duration 12 eyes (40%) of patients with central retinal vein occlusion (CRVO) and 18 eyes (60%) with branch retinal vein occlusion (BRVO) were injected with intravitreal bevacizumab 1.25 mg (0.05 ml) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25 mg/ml as a primary treatment. The mean number of injections was 2.7 (range, 1–6 injections) 6–8 weeks intervals and follow-up for 12 months (range, 9–13 months). Patients underwent visual acuity testing (VA) as functional assessment. Anatomically, optical coherence tomography (OCT) is used for measurement of central retinal thickness (CRT) to detect macular edema (ME), fundus photography and fluorescein angiography (FA) to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported. Results The mean age of all patients was 65.3 years ± 8.5 (range, 55–82 years), 20 males and 10 females patients. The mean baseline VA was 20/240 (log MAR 1.08 ± 0.52) and improved to 20/60 (log MAR 0.48 ± 0.32) with statistically significance difference change ( P < 0.001). The mean baseline CRT was 455 μm ± 126 (range, 386–510), decreased to 356 μm ± 118 (range, 296–416) after 1 month with statistically significance difference change ( P < 0.02) and to 402 μm ± 170 (range, 338–468) after 6 months ( P < 0.067) and to 250 μm ± 48 (range, 200–298) at last follow-up with statistically significance difference change from the baseline ( P < 0.001). There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1 month of injection. Neither systemic nor intraocular adverse events were reported. Conclusions Intravitreal Avastin (IVA) is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion.