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Combined photodynamic therapy and intravitreal bevacizumab as primary treatment for subretinal neovascularization associated with type 2 idiopathic macular telangiectasia.

Rishi P, Rishi E, Shroff D - Indian J Ophthalmol (2009 May-Jun)

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Dear Editor, The natural history of untreated subretinal neovascular membranes (SRNVM) associated with idiopathic macular telangiectasia (IMT) is generally poor with 81% of eyes in a series of 26 eyes having a final visual acuity of 20/200 or worse... Photodynamic therapy (PDT) and intravitreal bevacizumab have been used individually for treatment of such eyes; Combination PDT and ranibizumab has also been reported... Fundus examination of both eyes revealed Type 2A IMT with SRNVM in the right eye... The patient underwent PDT followed by intravitreal bevacizumab (1.25 mg/0.05 ml), the next day... At 12 weeks follow-up, visual acuity in the right eye improved to 20/200... Potter et al. reported an average of 2.4 PDT treatments for cessation of leakage... Intravitreal bevacizumab has been reported to improve visual outcome and reduce leakage in these cases... Bevacizumab would have a beneficial effect on SRNVM in IMT due to its location above the retinal pigment epithelium (RPE) and the presence of anastomotic retinal vascular connections which could facilitate the concentration of the dye in the SRNVM... At this stage, a combined approach using a non-thermal laser has been seen to be beneficial... Bevacizumab is a larger molecule (molecular weight ≈ 150 kD) with a slightly longer intravitreal half-life of 4.9 days as compared to three days for ranibizumab (molecular weight ≈ 50 kD)... Hence, a combination of PDT with bevacizumab may in some way, score over a combination of PDT with ranibizumab in such eyes... In conclusion, combination therapy using PDT and bevacizumab appears to be a promising approach in the primary management of SRNVM secondary to IMT.

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Color fundus picture (a) at the last follow-up reveals a completely regressed SRNVM. Optical coherence tomography (b) shows a high-reflective, scarred subretinal membrane
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Figure 0005: Color fundus picture (a) at the last follow-up reveals a completely regressed SRNVM. Optical coherence tomography (b) shows a high-reflective, scarred subretinal membrane

Mentions: A 60-year-old gentleman presented with diminution of vision in the right eye for two months. Best corrected visual acuity (BCVA) was 20/600 in the right eye and 20/60 in the left eye. Fundus examination of both eyes revealed Type 2A IMT with SRNVM in the right eye.[7] Clinical findings were confirmed on fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) [Figs. 1, 2]. The patient was informed about the various treatment options available and the ‘off label’ nature of bevacizumab. The patient underwent PDT followed by intravitreal bevacizumab (1.25 mg/0.05 ml), the next day. At 12 weeks follow-up, visual acuity in the right eye improved to 20/200. Clinically, SRNVM appeared to be regressing. The FFA showed minimal leakage [Fig. 3] and OCT revealed increased retinal thickness [Fig. 4]. Intravitreal bevacizumab (1.25 mg/0.05 ml) was repeated. At the last follow-up at 16 months, BCVA was maintained at 20/200 with a scarred SRNVM [Fig. 5].


Combined photodynamic therapy and intravitreal bevacizumab as primary treatment for subretinal neovascularization associated with type 2 idiopathic macular telangiectasia.

Rishi P, Rishi E, Shroff D - Indian J Ophthalmol (2009 May-Jun)

Color fundus picture (a) at the last follow-up reveals a completely regressed SRNVM. Optical coherence tomography (b) shows a high-reflective, scarred subretinal membrane
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683442&req=5

Figure 0005: Color fundus picture (a) at the last follow-up reveals a completely regressed SRNVM. Optical coherence tomography (b) shows a high-reflective, scarred subretinal membrane
Mentions: A 60-year-old gentleman presented with diminution of vision in the right eye for two months. Best corrected visual acuity (BCVA) was 20/600 in the right eye and 20/60 in the left eye. Fundus examination of both eyes revealed Type 2A IMT with SRNVM in the right eye.[7] Clinical findings were confirmed on fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) [Figs. 1, 2]. The patient was informed about the various treatment options available and the ‘off label’ nature of bevacizumab. The patient underwent PDT followed by intravitreal bevacizumab (1.25 mg/0.05 ml), the next day. At 12 weeks follow-up, visual acuity in the right eye improved to 20/200. Clinically, SRNVM appeared to be regressing. The FFA showed minimal leakage [Fig. 3] and OCT revealed increased retinal thickness [Fig. 4]. Intravitreal bevacizumab (1.25 mg/0.05 ml) was repeated. At the last follow-up at 16 months, BCVA was maintained at 20/200 with a scarred SRNVM [Fig. 5].

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, The natural history of untreated subretinal neovascular membranes (SRNVM) associated with idiopathic macular telangiectasia (IMT) is generally poor with 81% of eyes in a series of 26 eyes having a final visual acuity of 20/200 or worse... Photodynamic therapy (PDT) and intravitreal bevacizumab have been used individually for treatment of such eyes; Combination PDT and ranibizumab has also been reported... Fundus examination of both eyes revealed Type 2A IMT with SRNVM in the right eye... The patient underwent PDT followed by intravitreal bevacizumab (1.25 mg/0.05 ml), the next day... At 12 weeks follow-up, visual acuity in the right eye improved to 20/200... Potter et al. reported an average of 2.4 PDT treatments for cessation of leakage... Intravitreal bevacizumab has been reported to improve visual outcome and reduce leakage in these cases... Bevacizumab would have a beneficial effect on SRNVM in IMT due to its location above the retinal pigment epithelium (RPE) and the presence of anastomotic retinal vascular connections which could facilitate the concentration of the dye in the SRNVM... At this stage, a combined approach using a non-thermal laser has been seen to be beneficial... Bevacizumab is a larger molecule (molecular weight ≈ 150 kD) with a slightly longer intravitreal half-life of 4.9 days as compared to three days for ranibizumab (molecular weight ≈ 50 kD)... Hence, a combination of PDT with bevacizumab may in some way, score over a combination of PDT with ranibizumab in such eyes... In conclusion, combination therapy using PDT and bevacizumab appears to be a promising approach in the primary management of SRNVM secondary to IMT.

Show MeSH
Related in: MedlinePlus