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The therapeutic effects of bevacizumab in patients with polypoidal choroidal vasculopathy.

Lee SY, Kim JG, Joe SG, Chung H, Yoon YH - Korean J Ophthalmol (2008)

Bottom Line: No significant ocular or systemic side effects were observed in both groups.Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients.Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab for polypoidal choroidal vasculopathy (PCV).

Methods: In this retrospective interventional pilot study, 12 eyes of 11 patients with active PCV were treated with intravitreal bevacizumab (1.25 mg) alone or in combination with photodynamic therapy (PDT) depending on the informed patient's choice. Intravitreal bevacizumab was repeated at 6-week intervals until the regression of active lesion was detected on fluorescein angiography (FA) which was done on a regular basis, Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) analyses.

Results: Intravitreal bevacizumab was given alone in 8 eyes (Group 1) and in combination with PDT in 4 eyes (Group 2). Mean follow-up duration was 17 weeks in group 1 and 15 weeks in group 2 after bevacizumab treatment. The mean number of bevacizumab injections was 2.2 in group 1 and 2.5 in group 2. Mean BCVA improved from 20/63 to 20/40 in group 1 and 20/63 to 20/32 in group 2. Of all eyes, the BCVA improved by > or = 2 lines in seven (58%) eyes and resolution of fluid and hemorrhages in clinical examination, an absence of leakage on repeat FAs, or resolved pigment epithelial detachment (PED) and/or subretinal fluid (SRF) on OCT exam was confirmed in 10 (83%) eyes. Partial or complete regression of the polypoidal vessels and interconnecting vessels was reported for most cases at the last follow-up. No significant ocular or systemic side effects were observed in both groups.

Conclusions: Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients. Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.

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Case 3, left eye, the fellow eye of the case 4 patient (Fig. 1). (A) Midphase indocyanine green angiogram (ICGA), showing multiple polypoidal dilations of choroidal vessels and an interconnecting network. (B) Optical coherence tomograph (OCT) showing subfoveal serous elevation and a polypoidal lesion (arrow head). (C) Midphase ICGA showing reduced polypoidal lesion and interconnecting vessels. (D) OCT after three intravitreal bevacizumab injections, showing reduced subretinal fluid and a polypoidal lesion re-attached to the Bruch's membrane and choroids (arrow head).
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Figure 2: Case 3, left eye, the fellow eye of the case 4 patient (Fig. 1). (A) Midphase indocyanine green angiogram (ICGA), showing multiple polypoidal dilations of choroidal vessels and an interconnecting network. (B) Optical coherence tomograph (OCT) showing subfoveal serous elevation and a polypoidal lesion (arrow head). (C) Midphase ICGA showing reduced polypoidal lesion and interconnecting vessels. (D) OCT after three intravitreal bevacizumab injections, showing reduced subretinal fluid and a polypoidal lesion re-attached to the Bruch's membrane and choroids (arrow head).

Mentions: A 63-year-old man was referred to our clinic with a 5 month history of reduced visual acuity in the right eye. At the first visit, his visual acuity was 20/63 in the right eye and 20/20 in the left eye. Based on the findings in FA and ICGA, he was diagnosed as having PCV in his right eye and was treated with PDT covering whole active lesions. Four weeks after PDT, funduscopic examination of the right eye revealed extensive subretinal hemorrhage with a reduced visual acuity of 20/320. The right eye with massive subretinal hemorrhage was treated with intravitreal t-PA (50 µg) and 0.3 ml of 100% C3F8. Postoperative prone positioning was maintained for 72 hours. Two weeks after administration of t-PA injection and gas, funduscopic examination of the right eye showed dispersed and reduced subretinal hemorrhage (Fig. 1). At one month follow up, he complained a decreased vision to 20/50 in his untreated, left eye. The OCT examination demonstrated subfoveal serous elevation and FA/ICGA confirmed new active PCV in his left eye (Fig. 2). Both eyes were treated with an intravitreal injection of 1.25 mg bevacizumab, two injections in the right eye and three injections in the left eye, at 6 week intervals. The final visual acuity was 20/320 in the right eye with fibrovascular scarring and 20/32 in the left eye with minimal subfoveal serous elevation.


The therapeutic effects of bevacizumab in patients with polypoidal choroidal vasculopathy.

Lee SY, Kim JG, Joe SG, Chung H, Yoon YH - Korean J Ophthalmol (2008)

Case 3, left eye, the fellow eye of the case 4 patient (Fig. 1). (A) Midphase indocyanine green angiogram (ICGA), showing multiple polypoidal dilations of choroidal vessels and an interconnecting network. (B) Optical coherence tomograph (OCT) showing subfoveal serous elevation and a polypoidal lesion (arrow head). (C) Midphase ICGA showing reduced polypoidal lesion and interconnecting vessels. (D) OCT after three intravitreal bevacizumab injections, showing reduced subretinal fluid and a polypoidal lesion re-attached to the Bruch's membrane and choroids (arrow head).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629943&req=5

Figure 2: Case 3, left eye, the fellow eye of the case 4 patient (Fig. 1). (A) Midphase indocyanine green angiogram (ICGA), showing multiple polypoidal dilations of choroidal vessels and an interconnecting network. (B) Optical coherence tomograph (OCT) showing subfoveal serous elevation and a polypoidal lesion (arrow head). (C) Midphase ICGA showing reduced polypoidal lesion and interconnecting vessels. (D) OCT after three intravitreal bevacizumab injections, showing reduced subretinal fluid and a polypoidal lesion re-attached to the Bruch's membrane and choroids (arrow head).
Mentions: A 63-year-old man was referred to our clinic with a 5 month history of reduced visual acuity in the right eye. At the first visit, his visual acuity was 20/63 in the right eye and 20/20 in the left eye. Based on the findings in FA and ICGA, he was diagnosed as having PCV in his right eye and was treated with PDT covering whole active lesions. Four weeks after PDT, funduscopic examination of the right eye revealed extensive subretinal hemorrhage with a reduced visual acuity of 20/320. The right eye with massive subretinal hemorrhage was treated with intravitreal t-PA (50 µg) and 0.3 ml of 100% C3F8. Postoperative prone positioning was maintained for 72 hours. Two weeks after administration of t-PA injection and gas, funduscopic examination of the right eye showed dispersed and reduced subretinal hemorrhage (Fig. 1). At one month follow up, he complained a decreased vision to 20/50 in his untreated, left eye. The OCT examination demonstrated subfoveal serous elevation and FA/ICGA confirmed new active PCV in his left eye (Fig. 2). Both eyes were treated with an intravitreal injection of 1.25 mg bevacizumab, two injections in the right eye and three injections in the left eye, at 6 week intervals. The final visual acuity was 20/320 in the right eye with fibrovascular scarring and 20/32 in the left eye with minimal subfoveal serous elevation.

Bottom Line: No significant ocular or systemic side effects were observed in both groups.Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients.Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the efficacy and safety of intravitreal bevacizumab for polypoidal choroidal vasculopathy (PCV).

Methods: In this retrospective interventional pilot study, 12 eyes of 11 patients with active PCV were treated with intravitreal bevacizumab (1.25 mg) alone or in combination with photodynamic therapy (PDT) depending on the informed patient's choice. Intravitreal bevacizumab was repeated at 6-week intervals until the regression of active lesion was detected on fluorescein angiography (FA) which was done on a regular basis, Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) analyses.

Results: Intravitreal bevacizumab was given alone in 8 eyes (Group 1) and in combination with PDT in 4 eyes (Group 2). Mean follow-up duration was 17 weeks in group 1 and 15 weeks in group 2 after bevacizumab treatment. The mean number of bevacizumab injections was 2.2 in group 1 and 2.5 in group 2. Mean BCVA improved from 20/63 to 20/40 in group 1 and 20/63 to 20/32 in group 2. Of all eyes, the BCVA improved by > or = 2 lines in seven (58%) eyes and resolution of fluid and hemorrhages in clinical examination, an absence of leakage on repeat FAs, or resolved pigment epithelial detachment (PED) and/or subretinal fluid (SRF) on OCT exam was confirmed in 10 (83%) eyes. Partial or complete regression of the polypoidal vessels and interconnecting vessels was reported for most cases at the last follow-up. No significant ocular or systemic side effects were observed in both groups.

Conclusions: Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients. Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.

Show MeSH
Related in: MedlinePlus