Intravitreal Bevacizumab For Macular Edema Research Articles

Choroidal thickness as a possible predictor of non-response to intravitreal bevacizumab for macular edema after retinal vein occlusion

To evaluate outcomes of intravitreal bevacizumab (IVB) treating macular edema (ME) after retinal vein occlusion (RVO) following pro re nata (PRN) regimen and investigate potential predictors of non-response. Retrospective analysis of 126 treatment-naive eyes with ME after RVO. Eyes were treated initially with IVB of 1.25 mg/ml. Therapy was switched in case of non-response. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT), which were recorded over 4 years of treatment. BCVA improved significantly during first 2 years. CMT decreased significantly during the 4-year follow-up period. Switching was required in 42 eyes (33%). 34 eyes (26.9%) were switched to steroids, while 8 eyes (6.3%) were switched to other anti-VEGF due to diagnosed glaucoma. Switching occurred after 12.4 ± 8.3 months and an average of 8 ± 4.1 IVBs. Compared with the treatment-responsive group, the treatment-unresponsive group had significantly worse BCVA, higher CMT and subfoveal choroidal thickness (SFCT) at baseline. Treatment IVB following PRN regimen showed significant functional and anatomic improvement in patients with ME after RVO. Switching was required in more than one third of eyes. Higher baseline SFCT could be considered as predictor for non-response to such therapy and thus an indicator of early switching.

Comparison of Pro Re Nata and Three Loading Injections of Intravitreal Bevacizumab for Macular Edema in Branch Retinal Vein Occlusion

Comparison of Pro Re Nata and Three Loading Injections of Intravitreal Bevacizumab for Macular Edema in Branch Retinal Vein Occlusion

Effect of Intravitreal Bevacizumab in Macular Edema Caused by Branch Retinal Vein Occlusion

Purpose: To evaluate the effect of intra-vitreal bevacizumab in macular edema caused by branch retinal vein occlusion.
 Study Design: Interrupted time series study.
 Place and Duration of Study: Department of Ophthalmology Hayatabad Medical Complex, Peshawar and department of Ophthalmology Lady Reading Hospital Peshawar from 1st July 2016 to 31st December 2016.
 Material and Methods: There were 60 patients included in the study. All patients with macular edema due to BRVO visible clinically and evident on SD-OCT and visual acuity of less than 6/9 were included in the study. Patients who used other intra-vitreal drug for macular edema, those with surgery in the same eye and those with macular laser for macular edema were excluded from the study. All patients were given intra-vitreal 0.05 ml bevacizumab injection every month for 6 months. After 6 months OCT was repeated. At each monthly visit VA was measured and fundoscopy was done. Follow up of all patients was at six months.
 Results: Our study included 60 patients with mean age of 54.42 ± 9.19 years. The mean baseline central macular thickness was 427.06 µ with SD ± 63.54 µ. After 6 months significant improvement in visual acuity was documented. Also marked reduction in central macular thickness was noted after six months with mean of 327.44 µ with SD ± 55.55 µ.
 Conclusion: Intra-vitreal bevacizumab is an effective treatment for macular edema caused by BRVO in terms of both anatomic and visual improvement.
 Key words: Branch retinal vein occlusion, bevacizumab, macular edema.

Predictive Factors for a Favorable Response to Intravitreal Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

Predictive Factors for a Favorable Response to Intravitreal Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

Comment on "Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion".

Comment on "Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion".

Natural Short-term Course of Recurrent Macular Edema Following Intravitreal Bevacizumab Therapy in Branch Retinal Vein Occlusion.

PurposeTo evaluate the 3-month natural course of recurrent macular edema secondary to branch retinal vein occlusion (BRVO) treated with intravitreal bevacizumab.MethodsThis retrospective, observational study included 36 eyes with macular edema secondary to BRVO. All patients were initially treated with intravitreal bevacizumab for macular edema. Recurrence of macular edema was either not treated (untreated group) or treated with a single intravitreal bevacizumab injection (treated group). Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared at the time of recurrence and 3 months later.ResultsAt the time of recurrence, the mean CFT and logarithm of the minimum angle of resolution BCVA were 484.9 ± 124.1 µm and 0.58 ± 0.26 in the untreated group (n = 19) and 456.3 ± 126.8 µm and 0.51 ± 0.21 in the treated group (n = 17), respectively. Three months later, the mean CFT and BCVA had changed to 493.7 ± 123.9 µm and 0.62 ± 0.29 in the untreated group and 294.7 ± 104.4 µm and 0.40 ± 0.24 in the treated group, respectively. The differences in CFT and BCVA between the two time points were not significant in the untreated group (p = 0.106 and p = 0.687, respectively), whereas statistically significant differences were noted in the treated group (p = 0.002 and p < 0.001, respectively).ConclusionsUnlike the first episode of macular edema following BRVO, recurrent macular edema following intravitreal bevacizumab therapy did not spontaneously resolve, suggesting the potential benefit of prompt treatment.

Predictive factors for functional improvement following intravitreal bevacizumab injections after central retinal vein occlusion.

Vision loss in central retinal vein occlusion (CRVO) is mostly caused by macular edema (ME) and can be treated with intravitreal bevacizumab injections. The goal of this study was to identify predictive factors for improvement in visual acuity. Three hundred and sixteen eyes of six centres having received intravitreal bevacizumab for ME due to CRVO were enrolled in this multicentre, retrospective, interventional case series. The follow-up time was 24 to 48weeks. Investigated patient characteristics were pretreatment, duration of CRVO prior to the first injection, initial best-corrected visual acuity (BCVA), baseline central retinal thickness as measured by optical coherence tomography, gender, eye, age, comorbidity with glaucoma, systemic hypertension, or diabetes mellitus. Multiple regression analysis confirmed the following baseline predictive factors for an increase in visual acuity: low BCVA (p < 0.001), high CRT (p < 0.02), and treatment naïve patients (p = 0.03). None of the other investigated patient characteristics could be identified as prognostic factors for increase in visual acuity (p > 0.1). Intravitreal injections of bevacizumab in a routine clinical setting effectively improved and stabilized BCVA in CRVO. Our large multicenter study identified initial BCVA, baseline CRT, and pre-treatment as prognostic factors for visual improvement.

Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion.

To investigate the predictive factors for short-term effects of intravitreal bevacizumab injections on central subfield foveal thickness (CSFT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO. Follow-up was three months. The Early Treatment Diabetic Retinopathy Study (ETDRS) score and CSFT measured by spectral-domain optical coherence tomography (SD-OCT) were used to observe the changes in best-corrected visual acuity (BCVA). Baseline BCVA, CSFT, age, CRVO duration and the presence of cystoid macular edema (CME) or subretinal fluid (SRF) were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections. BCVA improved from 0.9 logMAR at baseline to 0.6 logMAR at 3mo, which was associated with a significant reduction in CSFT from 721 µm to 392 µm 3mo after injection. About 50% of CME cases and more than 90% of SRF cases responded to treatment with a complete resolution at 3mo. Age (P=0.036) and low baseline CSFT (P=0.037) were associated with a good 3-month prognosis. Patients >60 years old achieved better CME resolution (P=0.031) and lower CSFT at 3mo (305 µm vs 474 µm, P=0.003). Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo. Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes. The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF.

Comparison of single injection and three monthly injections of intravitreal bevacizumab for macular edema associated with branch retinal vein occlusion.

PurposeOur aim was to compare the 1 year efficacy and safety results of intravitreal bevacizumab (IVB) in two prospective, consecutive groups of patients with macular edema (ME) following branch retinal vein occlusion (BRVO).Patients and methodsTwenty-five eyes with ME after BRVO received one IVB injection (single-injection group) and 27 eyes received three monthly IVB injections (three-injection group). Both groups were followed monthly for 12 months. The best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) on optical coherence tomography were evaluated before and after treatment. Patients were eligible to receive an IVB injection if the mean CFT increased 100 μm or more or the BCVA decreased 0.1 logarithm of the minimum angle of resolution (logMAR) unit or more compared with values measured on the last visit.ResultsThe mean logMAR BCVA and CFT, respectively, improved from 0.56 to 0.33 and from 598 μm to 348 μm in the single-injection group (P<0.001) and from 0.55 to 0.26 and from 514 μm to 293 μm in the three-injection group (P<0.001). During the study period, the mean total number of injections was significantly smaller in the single-injection group than in the three-injection group (2.1 and 4.3, respectively, P<0.001). No serious complications related to the IVB injections developed in either group.ConclusionThe single-injection group achieved similar visual outcomes for ME secondary to BRVO with fewer injections compared with the three-injection group.

Twenty-Four-Month Results of Intravitreal Bevacizumab in Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose: The aim of this study is to evaluate the long-term efficacy of intravitreal bevacizumab (IVB) in macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real clinical practice setting at a tertiary referral center. Methods: A retrospective analysis of a final total number of 35 eyes of 35 patients with a 24-month follow-up was performed. Results: At 24 months, mean best-corrected visual acuity improved by 0.09 LogMAR units from baseline (95% CI: −0.03–0.24, p = 0.0674). The mean CFT decreased by 75 microns (95% CI: 27–123, p = 0.0026). The median number of injections was 6 (IQR: 3–9). Macular edema showed complete resolution in 12 eyes (34.3%), responded partially in six eyes (17%), recurred in eight eyes (23%), and remained persistent in nine eyes (25.7%, three eyes at six months, one eye at 12 months, three eyes at 18 months and two eyes at 24 months). Conclusion: Our study shows that treatment with IVB in patients with ME due to BRVO during a period of 24 months provided complete resolution of the ME in more than one-third of patients. In one-third of the cases, ME resolved partially or recurred and in less than one-third of patients ME remained persistent. Visual acuity increased significantly in 23% of patients and remained stable in the majority of patients. However, a median number of six injections was necessary to maintain a lasting beneficial effect. Further long-term prospective studies are required comparing intravitreal bevacizumab with other treatment modalities.

Monthly Intravitreal Bevacizumab for Macular Edema after Iodine-125 Plaque Radiotherapy of Uveal Melanoma

To examine the efficacy of monthly injections of intravitreal bevacizumab (IVB) for macular edema after iodine-125 plaque radiotherapy of uveal melanoma. We studied 36 patients with macular edema after plaque radiotherapy of uveal melanoma in this noncomparative, interventional case series. All eyes were treated with 4 monthly injections of IVB. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were measured before each injection and 4-6 months after the first injection. The main outcome measures were change in CMT and BCVA. At 4-6 months following the first IVB, 20 eyes (56%) had decreased CMT, 11 eyes (31%) had stable CMT, and 5 eyes (14%) had increased CMT. The mean change in CMT and the mean percent change in CMT at 4-6 months compared to baseline were -91 µm (-20%) in all eyes, -174 µm (-37%) in the group with decreased macular thickness, -14 µm (-3%) in the group with stable macular thickness, and +69 µm (+17%) in the group with increased macular thickness. At 4-6 months, 15 eyes (42%) had increased BCVA, 16 eyes (44%) had stable BCVA, and 5 eyes (14%) had decreased BCVA. An increase in CMT was seen between the fourth monthly IVB injection and the final evaluation at 4-6 months after the first injection in all 3 groups of our study. At 4-6 months following the first injection, 4 monthly injections of IVB in eyes with macular edema after plaque radiotherapy of uveal melanoma decreased macular edema in 56% and improved BCVA in 42% of the treated eyes.

Correlation between optical coherence tomographic hyperreflective foci and visual outcomes after intravitreal bevacizumab for macular edema in branch retinal vein occlusion

To investigate the correlation between hyperreflective foci (HF) on spectral-domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection (IVB) in branch retinal vein occlusion. We retrospectively studied 97 eyes of 97 patients with macular edema secondary to BRVO, who were treated with IVB. The eyes were divided into three groups according to the location of HF on SD-OCT: HF in outer retinal layers, HF in inner retinal layers, and no HF. The baseline and final best-corrected visual acuity (BCVA), foveal thickness (FT), external limiting membrane (ELM) status, junction between photoreceptor inner and outer segments (IS/OS) status, and the number of HF were evaluated and compared among three groups. Baseline BCVA was correlated with baseline FT (R = 0.366, p < 0.001), but final BCVA was not correlated with final FT (R = -0.008, p = 0.942). Baseline BCVA was significantly better in eyes with intact ELM at baseline (p = 0.006), and final BCVA was significantly better in eyes with intact ELM and IS/OS at final visit (p < 0.001, p = 0.003 respectively). At the final visit, 15 of 37 eyes (40.5%) with HF in outer retinal layers had a disrupted ELM (p = 0.001), while 28 of 37 eyes (75.7%) with HF in outer retinal layers had a disrupted IS/OS (p < 0.001). Final BCVA was poorer in eyes with HF in outer retinal layers groups than those in the other two groups (p < 0.001), although baseline BCVA was not different between them. HF on SD-OCT at baseline might predict the photoreceptor status and final VA after IVB in BRVO.

Intravitreal ranibizumab following bevacizumab for macular edema due to retinal vein occlusion

AbstractPurpose Macular edema is the main cause of visual impairment secondary to retinal vein occlusions (RVO). Current treatment is based on intravitreal injections of corticosteroids or VEGF inhibitors. Bevacizumab was first used in the eye on an off‐label basis, whereas ranibizumab was approved in this indication in January 2012 in France. Our work’s objective was to analyse the becoming of patients who received bevacizumab then ranibizumab successively in management of RVO.Methods This study includes the patients treated effectively with intravitreal bevacizumab for macular edema due to RVO and next treated with intravitreal ranibizumab. We included 9 patients presented with a central retinal vein occlusion (CRVO) and 6 patients with a branch retinal vein occlusion (BRVO). Ophthalmological examination performed after intravitreal injections consists in logMAR visual acuity and central macular thickness measurement by OCT.Results Intravitreal injections of anti‐VEGF allowed an improvement of the visual acuity and a reduction of the central macular thickness. Final visual acuity was better after treatment with ranibizumab than after bevacizumab in patients presenting with CRVO ( the average gain of visual acuity was 0.30 logMAR). No infectious complication was noted.Conclusion The therapeutic transition from bevacizumab to ranibizumab stabilizes both visual acuity improvement and decrease of macular thickness even in long time treated patients, despite vision impairment produced by old edema, worsening cataract, or apparition of retinal ischemia areas. In this short series of patients, replacement of bevacizumab by ranibizumab didn’t have negative impact on visual results despite treatment was continued on a longer time course.

Spectral-domain optical coherence tomography (SD-OCT) patterns and response to intravitreal bevacizumab therapy in macular edema associated with branch retinal vein occlusion

To evaluate the baseline spectral-domain optical coherence tomography (SD-OCT) characteristics of macular edema (ME) due to branch retinal vein occlusion (BRVO) for visual outcome after intravitreal bevacizumab injection. Fifty-nine patients treated in one eye with intravitreal bevacizumab for ME due to BRVO were retrospectively reviewed. Stepwise multiple regression analysis was used to evaluate the relative contribution of several variables, including SD-OCT characteristics such as photoreceptor inner segment/outer segment (IS/OS) integrity and external limiting membrane (ELM status), baseline best-corrected visual acuity (BCVA), and baseline central retinal thickness (CRT) with final visual outcome. Thirty-one patients (52.5 %) had disrupted photoreceptor IS/OS integrity. The mean BCVA improved significantly from 0.50 logMAR (20/63 Snellen equivalent) to 0.10 logMAR (20/25 Snellen equivalent) in the intact photoreceptor group (p = 0.000, paired t-test). However, the mean BCVA was improved in the disrupted photoreceptor group, from 1.10 logMAR (20/252 Snellen equivalent) to 0.94 logMAR (20/174 Snellen equivalent), which was not statistically significant (p = 0.177, paired t-test). ELM was disrupted in 23 patients (39.0 %). The mean BCVA improved significantly from 0.63 logMAR (20/85 Snellen equivalent) to 0.26 logMAR (20/36 Snellen equivalent) in the intact ELM group (p = 0.000, paired t-test), however, not significantly improved in the disrupted ELM group, from 1.09 logMAR (20/246 Snellen equivalent) to 1.01 logMAR (20/205 Snellen equivalent) (p = 0.563, paired t-test). The strongest individual predictor of final BCVA among patients with ME due to BRVO was the integrity of photoreceptor IS/OS layer on SD OCT (r (2) = 0.514, p = 0.000, stepwise multiple regression), but the most efficient model was the combination of the photoreceptor IS/OS integrity, ELM status, and baseline BCVA (r(2) = 0.671, p = 0.000, stepwise multiple regression). The strongest predictor of final BCVA was the status of photoreceptor IS/OS integrity (β = 0.532, p = 0.000, stepwise multiple regression), followed by ELM status (β = 0.325, p = 0.006, stepwise multiple regression), and the baseline BCVA (β = 0.238, p = 0.013, stepwise multiple regression). Our results suggest that baseline SD-OCT characteristics, the status of photoreceptor IS/OS and ELM can be helpful in predicting the final visual outcome after intravitreal bevacizumab injection in these patients.

Functional and Anatomic Response of the Retina and the Choroid to Intravitreal Bevacizumab for Macular Edema

This study evaluated the rate of change of best corrected visual acuity (BCVA), central retinal sensitivity, and retinal and choroidal thickness in patients with macular edema after intravitreal bevacizumab. This was a prospective, nonrandomized, interventional study. Thirty-four consecutive eyes (34 patients) with macular edema were included in the study. Choroidal neovascularization was present in 21 cases, stage 1 retinal angiomatous proliferation in 6 cases, branch retinal vein occlusion in 4 cases, and diabetic edema in 3 cases. Evaluation of BCVA (Early Treatment Diabetic Retinopathy Study [ETDRS] logarithm of the minimum angle of resolution [LogMAR]), central retinochoroidal thickness (RCT) at standardized A-scan, combined optical coherence tomography/microperimetric assessment of central retinal thickness (RT), central scotoma, and fixation behavior was performed during 12 months after treatment. Choroidal thickness was considered as the difference between RCT and RT. All patients received two initial intravitreal bevacizumab injections (1.25 mg/0.05 mL) at a 1-month interval. BCVA and RT during follow-up were significantly better than at baseline. BCVA was improved of 0.32±0.3 LogMAR (P<0.001) at month 1, 0.18±0.4 LogMAR (P=0.05) at month 6, and 0.14±0.2 (P=0.09) at month 12. RT was reduced by 172.9±192.8 μm (P<0.001) at month 1, 157.7±134.2 μm (P=0.003) at month 6, and 164.3±122.3 (P=0.002) at month 12. Mean retinal sensitivity significantly increased during the first month; it decreased afterward, but an improvement if compared with baseline was present at each visit during follow-up. In 23.5% of cases, a choroidal thinning was present during follow-up, and in this group visual acuity at baseline and final visual improvement were significantly greater if compared with patients showing a choroidal thickening. Intravitreal bevacizumab for macular edema determines significant functional and anatomic improvement at the 12-month follow-up. Visual acuity at baseline and following treatment could be influenced by the choroidal involvement.

Intravitreal Bevacizumab for Macular Edema Due to Central Retinal Vein Occlusion: Perfused vs. Ischemic and Early vs. Late Treatment

Purpose/aims: This study investigates the efficacy of intravitreal bevacizumab (IVB) for cystoid macular edema (CME) secondary to central retinal vein occlusion (CRVO). Subgroup analysis was performed comparing early (within 90 days of CRVO onset) and late treatment (after 90 days) as well as perfused and ischemic subgroups.Materials and Methods: Retrospective review of 48 consecutive eyes with CRVO treated with IVB was performed. Data collected at various time points included best corrected visual acuity (BCVA), central foveal thickness (FT) on optical coherence tomography (OCT), perfusion status on fluorescein angiography (FA), and complications.Results Mean initial BCVA was 20/288 compared to 20/214 at 12 months (p = 0.07) and 20/204 (p = 0.03) at final follow-up. Initial mean central FT was 591 micrometers compared to 339 micrometers at 12 months (p = 0.003). Mean follow-up was 10.5 months, and mean number of injections was 3.7. After IVB, no significant difference in BCVA gain or edema resolution on OCT was noted between the early and late treatment groups or between the perfused and ischemic subgroups.Conclusions: IVB improves foveal thickness in eyes with CRVO, but this does not always correlate with visual recovery. No difference in efficacy was observed for IVB treatment of perfused versus ischemic CRVO or when used for early versus late treatment.

Effect of intravitreal bevacizumab in macular edema of central retinal vein occlusion

Effect of intravitreal bevacizumab in macular edema of central retinal vein occlusion

Intravitreal bevacizumab for macular edema due to branch retinal vein occlusion: 12-month results

Purpose:To present the functional and anatomic changes after intravitreal bevacizumab in eyes with macular edema (ME) due to branch retinal vein occlusion (BRVO).Design:The study was a retrospective study.Materials and methods:The study included 31 patients with ME due to BRVO. We compared the examination findings of patients with ME before and after intravitreal bevacizumab therapy at 12 months. The study included patients who had macular edema secondary to BRVO treated with bevacizumab. The therapy was started in the first week after occlusion. The initial therapy was three intravitreal bevacizumab injections at monthly intervals with 1.25/0.05 mL bevacizumab. Patients with a baseline visual acuity less than 0.5 (logarithm of the minimum angle of resolution [logMAR] 0.30), central macular thickness (CMT) more than 290 μm, and no neovascularization were included. Patients with diabetes mellitus or a history of intravitreal triamcinolone or grid laser photocoagulation therapy or ischemic BRVO were excluded. The retreatment criteria were as follows: increased CMT more than 100 μm combined with a loss of visual acuity of five or more letters. The statistical analysis of this study was carried out by paired samples t-test (SPSS). A P value of less than 0.05 was considered to be statistically significant.Results:This retrospective study included 33 eyes of 31 patients (20 women, 11 men; mean age was 55.30 ± 9.62 years (range 36–75 years). Patients received a mean of 5.3 injections during 12 months of follow-up. The best corrected visual acuity increased from 0.66 ± 0.20 (logMAR) at baseline to 0.22 ± 0.13 (logMAR) (t = 15.42; P < 0.001) at month 12. The CMT decreased from 494.15 ± 104.16 μm at baseline to 261.79 ± 45.36 μm at month 12 (− 232.36 ± 109.98 μm); P < 0.001). No bevacizumab-related systemic or ocular adverse effects following intravitreal drug injections were observed. The majority of patients required reinjection(s) treatment for ME (84.9%).Conclusion:Intravitreal therapy using bevacizumab appears to be an effective primary treatment option for ME due to BRVO. No serious ophthalmologic or systemic side effects were observed for intravitreal bevacizumab therapy. The main disadvantage of bevacizumab therapy is the requirement of multiple injections in order to maintain visual and anatomic improvements.

Visual acuity following intravitreal bevacizumab for macular edema associated with retinal vein occlusion

To study prognostic factors for visual acuity (VA) after intravitreal bevacizumab injection (IVB) for macular edema (ME) associated with retinal vein occlusion (RVO), by evaluating the correlation between the final VA and VA at baseline and at 1, 3, and 6 months after the initial IVB. We studied retrospectively 79 eyes of 79 patients with ME secondary to RVO treated with IVB. The correlation between the final VA and VA at each visit was studied by using Pearson's correlation coefficient. Baseline VA was significantly correlated with the final VA (r = 0.552, P < 0.0001). Postoperative VA at 1, 3, and 6 months after the initial IVB, however, was even more closely correlated with the final VA (r = 0.793, 0.816, 0.893, respectively; P < 0.0001 in each case). Additionally, eyes with a VA of 20/40 or better at 1 month achieved a significantly better final VA than did eyes with a VA worse than 20/40 at 1 month (P < 0.0001). This tendency was seen also in each RVO subgroup. Although the baseline VA was significantly correlated with the final VA, postoperative VA was correlated even more closely with the final VA. VA shortly after the initial IVB seemed to reliably predict final visual outcome.

Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up

To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin((R))) as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma. A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA) 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA) was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin((R))) was recommended. The injections were performed on a six-weekly basis. The central retinal thickness prior to the treatment was 458 mum. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 mum. After the third injection, the central retinal thickness was 359 mum and 18 months after presentation, it reduced to 334 mum. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period. Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.