A case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in angioid streaks

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 μm at baseline to 203 μm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.     

Intravitreal bevacizumab for the management of choroidal neovascularization in pseudoxanthoma elasticum

PURPOSE: To determine the results of intravitreal bevacizumab injections for the management of choroidal neovascularization (CNV) in patients with pseudoxanthoma elasticum (PXE)-associated angioid streaks. METHODS: A consecutive series of patients with PXE and CNV were managed with intravitreal bevacizumab injection (1.25 mg per 0.05 cc). The main outcome measures were visual acuity and greatest lesion height as measured by optical coherence tomography (OCT). RESULTS: Nine eyes of nine consecutive patients received intravitreal bevacizumab (1.25 mg/0.05 mL) injections. The mean follow-up time was 6 months, during which eyes received an average of 1.8 injections. The baseline visual acuity was a mean of 20/368 and improved to 20/289 at the last visit (P = 0.056). Visual acuity either improved or stabilized in all 9 eyes (100%). Serial OCT measurements in 8 eyes showed a mean of 353 microm at baseline, which decreased to 201 mum at the last visit (P = 0.012). No complications were noted. CONCLUSIONS: These short-term results support the use of intravitreal bevacizumab for the management of CNV in patients with PXE. Continued experience with intravitreal bevacizumab in this population will help establish its longer-term efficacy and better define the potential need for serial injections to maintain these results.     

Intravitreal bevacizumab for extrafoveal choroidal neovascularization after ocular trauma

Abstract Purpose: To describe two cases of extrafoveal choroidal neovascularization (CNV) after ocular trauma successfully treated with intravitreal bevacizumab injection. Methods: A 41-year-old man presented for progressive visual impairment in the left eye (LE). The patient had a positive history for pseudoxanthoma elasticum and suffered a blunt trauma in the LE 1 year before. Best-corrected visual acuity (BCVA) in the affected eye was 20/100. Fundus examination of the LE revealed angioid streaks and a choroidal rupture with retinal hemorrhages. Fluorescein angiography (FA) revealed an extrafoveal CNV and optical coherence tomography (OCT) findings demonstrated the presence of intraretinal fluid extending to the fovea. The second patient was a 61-year-old man complaining of blurred vision in the LE. Fundus examination of the LE revealed retinal pigment epithelium (RPE) changes, while FA showed the presence of an extrafoveal CNV close to the area of RPE attenuation. Intraretinal fluid extending to the fovea was detectable on OCT examination. An intravitreal injection of bevacizumab was proposed in both cases. Results: In the first patient, treatment with one intravitreal bevacizumab injection was successful in contrasting CNV activity, as OCT findings showed a resolution of intraretinal fluid accumulation. BCVA remained unchanged (20/100) over the 12-month follow-up period, most probably due to permanent alteration of the photoreceptors. In the second case, BCVA improved from 20/40 to 20/20 with complete resolution of leakage on FA and fluid on OCT 1 month after a single intravitreal injection of bevacizumab. Visual function remained stable over the 14-month follow-up. Conclusions: Our results indicate that intravitreal bevacizumab is effective in the management of extrafoveal CNV secondary to ocular trauma.     

Anti-vascular endothelial growth factor treatment for choroidal neovascularization secondary to angioid streaks in pseudoxanthoma elasticum：a case report and systemic review

The present study reports a case of a patient with choroidal neovascularization (CNV) associated with pseudoxanthoma elasticum (PXE). We observed the functional and anatomical improvement of the patient treated with intravitreal vascular endothelial growth factor (VEGF) inhibitor bevacizumab. The study also systematically searched the database for similar cases to provide a literature review. Data concerning the clinical features, treatment strategies and outcomes were extracted and analyzed. Retrospective interventional case report and systematic literature review. A 56-year-old healthy Chinese woman with CNV secondary to PXE was reported. Examinations included best corrected visual acuity (BCVA), biomicroscopy, optical coherence tomography (OCT), lfuorescein and indocyanine green angiography and digital fundus photography. The patient managed with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections (bevacizumab 1.25 mg/0.05 mL). The Cochrane Library, PubMed, OVID, and UpToDate databases were searched using the term pseudoxanthoma elasticum or Gr?nblad-Strandberg syndrome with the limits English. Articles that predated the databases were gathered from current references. Fundus examination revealed angioid streaks bilaterally and CNV in left eye (LE). After the patient underwent three intravitreal injections of bevacizumab, the LE showed absorption of the subretinal lfuid and shrinkage of the CNV. Visual acuity (VA) was improved in her treated LE. Bevacizumab treatment was well tolerated with no adverse events reported. Approximately ten articles about 45 patients (49 eyes) describing CNV secondary to angioid streaks in PXE treated with anti-VEGF were found in the literature search. In the present case, bevacizumab of an initial three injection loading dose, achieved maintenance of visual function in the treatment of CNV associated with angioid streaks in PXE. Literature articles concluded that the intravitreal application of anti-VEGF is highly efifcient for improving and stabilizing the lesion as well as the eyesight. So we believe that anti-VEGF therapy can be a great choice of treatment for CNV secondary to angioid streaks related PXE.     

Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration

PURPOSE: To investigate the efficacy and safety of intravitreal bevacizumab for managing choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). DESIGN: Prospective interventional case series. METHODS: Seventeen eyes of 17 patients with subfoveal CNV due to AMD participated in this study at the American University of Beirut Ophthalmology Clinics. All patients had failed, refused, or were not eligible for photodynamic therapy. All eyes received a baseline eye examination, which included best-corrected visual acuity (BCVA), dilated fundus examination, ocular coherence tomography (OCT) imaging, and fluorescein angiography. An intravitreal injection of bevacizumab (2.5 mg/0.1 ml) was given at baseline and followed by two additional injections at four-week intervals. BCVA, OCT, and fluorescein angiography were repeated four weeks after each injection. Main outcome measures were improvement in BCVA and central retinal thickness (CRT). RESULTS: Mean baseline BCVA was 20/252 (median 20/200), and baseline CRT was 362 microm (median 350 microm). Improvement in VA and CRT occurred by the fourth week. At 12 weeks, mean BCVA was 20/76 (P < .001) and median BCVA was 20/50 (P < .001). Both mean and median CRT decreased to 211 microm (P < .001). Thirteen (76%) of 17 eyes had total resolution of subretinal fluid, and four eyes (24%) had BCVA better than 20/50. No systemic or ocular side effects were noted at any time. CONCLUSION: Eyes with CNV due to AMD treated with intravitreal bevacizumab had marked anatomic and visual improvement. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.     

抗VEGF药物玻璃体内注射治疗视网膜血管样条纹继发脉络膜新生血管的远期观察

目的 探讨视网膜血管样条纹继发脉络膜新生血管(choroidal neovascularization,CNV)抗VEGF治疗的远期疗效.方法 回顾分析接受玻璃体内注射抗VEGF药物的视网膜血管样条纹继发CNV患者,观察至少3 a后患者视力改善情况、视网膜及脉络膜活动性病灶消退情况等指标.结果 纳入分析的21例(30眼)患者中,眼内注射次数6 ～18(10.0±2.4)次.随访36 ～54(39.5±2.2)个月.患者首次接受治疗时BCVA为(31.00±3.81)个字母数,观察终点时最佳矫正视力为(34.00±0.35)个字母数,总体差异无统计学意义(P=o.600).患者治疗前视网膜中央厚度为(406.21±21.23) μm,随访终末时为(251.16±36.36)μm,减少值为(150.21±24.43).μm,治疗前后视网膜中央厚度比较差异有统计学意义(P =0.002).30眼中16眼在初期治疗后视力明显提升,但随访中出现病变复发活跃后视力再次下降至基线水平;10眼在病变过程中出现不同程度黄斑下萎缩及瘢痕化改变,随访过程及随访终末视力与基线视力差异均无统计学意义(均为P ＞0.05);4眼由于初始CNV未累及黄斑区,在治疗随访过程中CNV稳定.结论 由于病变的高复发性及强活跃性,抗VEGF药物治疗血管样条纹继发CNV远期预后并不理想,治疗仅发挥了一定维持视功能的作用.     

眼底血管样条纹并发脉络膜新生血管的临床特征及联合治疗

目的 分析眼底血管样条纹（AS）并发CNV的临床特征,探讨光动力疗法（PDT）联合玻璃体腔注射雷珠单抗治疗AS合并黄斑病变的临床疗效及安全性。方法 回顾性系列病例研究。分析21例（42眼）AS的临床资料,包括BCVA、眼底表现、FFA、ICGA以及OCT。其中18例（22眼）合并黄斑CNV,先采用PDT治疗,3 d内玻璃体腔注射雷珠单抗,治疗后定期随访,至少随访12个月。随访时如发现视力下降、黄斑区出现新病灶、视网膜下或层间积液、CNV活动性病变,则重复玻璃体腔注射。数据采用独立样本t检验或配对样本t检验进行分析。结果 本组21例患者均双眼发病,仅5例（24%）合并全身病变,男性为主（76%）,其中18例（86%）继发黄斑CNV,BCVA显著低于病变未侵及黄斑者。联合治疗的22眼末次随访时BCVA较治疗前提高10.4个字母;OCT示治疗后黄斑区视网膜厚度从基线的（338.4±55.2）μm降至（212.6±36.2）μm;FFA（ICGA）显示15眼（68%）CNV完全闭合,渗漏消失,5眼呈瘢痕染色。所有患者接受1次PDT,平均玻璃体腔注射次数3.2次。1例PDT后出现黄斑区视网膜下出血,行玻璃体腔注射雷珠单抗后出血吸收,5例发生一过性眼压升高,4例出现结膜下出血,均完全恢复,无其他明显眼部及全身不良反应。结论 眼底AS具有特殊的眼底表现,FFA（ICGA）有助于明确诊断,相当比例的患者可继发黄斑部CNV。PDT联合玻璃体腔注射雷珠单抗能有效控制AS合并黄斑病变的病情进展,显著改善患者视功能,减少CNV渗漏,且不良反应少。     

Intravitreal bevacizumab (avastin) for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab in the treatment of idiopathic choroidal neovascularization (CNV) and CNV secondary to central serous chorioretinopathy (CSC) or punctate inner choroidopathy (PIC). DESIGN: Prospective, nonrandomized, interventional case series. METHODS: In an institutional clinical practice, 15 patients were recruited; nine had idiopathic CNV, two had CNV secondary to CSC, and four had CNV attributable to PIC. Patients received three monthly 1.25-mg intravitreal bevacizumab injections for three months. Patients were followed for six months, and the best-corrected visual acuity (BCVA), fluorescein angiography (FA) findings, and optical coherence tomography (OCT) central foveal thickness (CFT) were assessed. RESULTS: At baseline, the mean logMAR BCVA was 0.48 (Snellen equivalent = 20/60). The mean logMAR BCVA improved significantly to 0.25 (Snellen equivalent = 20/36) and 0.17 (Snellen equivalent = 20/30) at one and six months, respectively (both P = .001). The mean OCT CFT reduced from 306 microm at baseline to 201 microm at six months (P < .001). All eyes (100%) had visual improvement of 1 line or more at six months, and 11 (73.3%) improved by 2 or more lines. FA showed absence of CNV leakage, the angiographic end point, at three months, and no recurrence was observed at six months in all eyes. No systemic or ocular adverse events were encountered. CONCLUSIONS: Intravitreal bevacizumab injections resulted in visual and anatomic improvements in eyes with idiopathic CNV and CNV attributable to CSC or PIC. Further studies are warranted to assess the long-term safety and the regimen for optimal efficacy of intravitreal bevacizumab.     

Effect of intravitreal bevacizumab (Avastin®) in neovascular age‐related macular degeneration using a treatment regimen based on optical coherence tomography: 6‐ and 12‐month results

Purpose: To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age‐related macular degeneration (AMD) within a follow‐up period of 6 and 12 months. Methods: A retrospective analysis of 102 eyes of 102 consecutive patients with neovascular AMD evaluated repeated intravitreal bevacizumab (1 or 2.5 mg) injections. Retreatment was performed following an optical coherence tomography (OCT)‐based regimen. Ophthalmic examination included best‐corrected visual acuity (BCVA), dilated fundus examination and OCT imaging. Data were analysed at baseline, 6 months (24 weeks) and 12 months (48 weeks) after treatment initiation. Results: BCVA remained stable at 6 months (mean: 0.00 ± 0.41 logMAR; p = 0.95) and 12 months (mean: +0.02 ± 0.43 logMAR; loss of ～ 1 letter; p = 0.70) after the first treatment. OCT retinal thickness decreased by a mean of ?37.8 ± 101.6 μm (p < 0.05) compared to baseline at month 6 and ?38.6 ± 93.3 μm (p < 0.05) at month 12. A mean of 2.6 ± 1.2 injections were needed to obtain absence of fluid by OCT, and the time to recurrence was 23 ± 11 weeks thereafter. There was no difference in BCVA and OCT outcomes between treatment‐naive eyes and eyes that had undergone prior treatment. Conclusion: The 6‐ and 12‐month follow‐up of repeated intravitreal bevacizumab therapy in eyes with neovascular AMD demonstrated stabilization of vision and no safety concerns. An OCT‐based retreatment strategy appears appropriate in the management of patients treated with intravitreal bevacizumab.     

Treatment of choroidal neovascularization using intravitreal bevacizumab

PURPOSE: This study aimed to assess the pharmacodynamic profile of intravitreal bevacizumab in relation to best corrected visual acuity (BCVA), foveal thickness, and other aspects of macular morphology after intravitreal injection of bevacizumab in eyes with subretinal choroidal neovascularization (CNV). METHODS: A retrospective observational, uncontrolled case series including 26 eyes in 25 patients followed for up to 6 months after intravitreal injection of bevacizumab 1 mg repeated as deemed necessary after monthly assessments by biomicroscopy, optical coherence tomography, colour fundus photography, fluorescein angiography and BCVA determination. At follow-up, cases were classified by morphological treatment response (reduction or elimination of pathological neovascular leakage, retinal thickening or serous retinal detachment) or absence of response (deterioration or lack of improvement). Primary disease entities included age-related macular degeneration (22 eyes, four of which had evidence of retinal angiomatous proliferation), idiopathic peripapillary neovascularization (one eye), and angioid streaks (three eyes in two patients). RESULTS: One month after the first injection, apparent morphological improvement was observed in 24/26 eyes and mean BCVA had improved by 3.1 +/- 7.8 letters (p = 0.05). Of these 24 responders, which included all primary diagnoses, 11 (46%) demonstrated BCVA improvement of >or= 5 letters. The two non-responders (7.7%) had lost > 3 lines of vision at 2 months follow-up. Overall, 18 eyes completed 6 months follow-up, with a mean BCVA improvement of 0.5 +/- 12.7 letters, and 22 eyes completed 3 months follow-up, with a mean BCVA improvement of 2.0 +/- 11.0 letters. Two months after the first injection, 11 (46%) of the 24 responders demonstrated signs of recurrent CNV activity, defined as decreased BCVA and/or increased retinal thickness and/or fluorescein angiographic CNV leakage. No serious drug-related adverse events were observed during the course of the study. CONCLUSIONS: Overall mean BCVA remained stable throughout the study. Morphological signs of reduced CNV activity were seen in the majority of eyes at 2-4 weeks after intravitreal bevacizumab injection. Half the responders showed signs of renewed CNV activity at 2 months after their first injection. All first-injection responders were also second-injection responders.     

Intravitreal bevacizumab for choroidal neovascularization secondary to angioid streaks: A report of two patients

The aim of this study is to report clinical course of choroidal neovascularization secondary to angioid streaks (AS) in two patients who underwent intravitreal bevacizumab therapy. Fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT) revealed the diagnosis of subfoveal classic choroidal neovascularization (CNV) in the right eye in patient 1 and in the left eye in patient 2. After three consecutive bevacizumab injections, visual acuity improved from 20/40 to 20/25 in patient 1 and from 20/80 to 20/50 in patient 2. After 3 months of therapy, additional bevacizumab injection was administered when the lesion showed recurrence. After a follow-up time of 24-months, patient 1 received 14 intravitreal bevacizumab injections; patient 2 received only 4 injections. Visual acuities remained stable at 20/32 and 20/50 in patient 1 and patient 2, respectively. Though, the patients of CNV secondary to AS showed similar clinical appearance at the beginning, this report provides the data for different responses to intravitreal bevacizumab therapy. While fewer injections were required to control the disease in one patient, the other patient needed much more injections for stabilization of the CNV. Further studies are required to understand the cause of varied treatment responses in those patients.     

抗血管内皮生长因子单克隆抗体bevacizumab治疗渗出型老年性黄斑变性疗效观察及无效病例分析

目的 观察玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab(IVB)治疗渗出型老年性黄斑变性(AMD)的效果,分析治疗无效的原因.方法 开放性、单一治疗组的前瞻性研究.经最佳矫正视力(BCVA)、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)及光相干断层扫描(OCT)检查确诊为渗出型AMD的17例患者18只眼纳入研究.确诊并取得患者知情同意后行第1次IVB治疗.此后第6、12、24、36、48周分别行第2、3、4、5、6次IVB治疗.治疗前及每次治疗后均行BCVA、眼压、裂隙灯显微镜、眼底、彩色眼底照相、OCT检查,于治疗前及第6、24、52周行FFA和ICGA检查.以末次随访患者BCVA所见字母数增加、不变或减少＜5个为治疗有效,字母数减少≥5个为治疗无效;观察其治疗效果.对比分析治疗无效患眼治疗前后OCT测得的黄斑中心凹视网膜厚度(CMT)、病变最大处视网膜厚度( MRT)变化以及FFA和ICGA的形态学变化情况.结果 18只眼中,有效12只眼,占66.67％;无效6只眼,占33.33％.无效眼治疗前平均CMT、MRT为506.83、635.33μtm,治疗后平均CMT、MRT为446.17、563.67 μm;治疗后较治疗前分别降低了60.67、71.67 μm,差异均无统计学意义(t=-1.572,-0.943;P=0.116,0.345).FFA及ICGA检查发现,治疗无效的6只眼中,3只眼病灶位于黄斑中心凹区域内,整个治疗过程中未见病灶反复活动,第6次治疗后病灶均出现大片状瘢痕化.另3只眼在第3次治疗后黄斑区病灶面积扩大,荧光渗漏,CNV呈花环样;第6次治疗后,黄斑区荧光渗漏较第3次治疗后减轻,部分病灶瘢痕化.OCT检查发现,治疗无效眼神经上皮脱离减轻,视网膜色素上皮与脉络膜光带较治疗前光滑,但仍有增厚、隆起,黄斑区视网膜水肿.结论 IVB治疗渗出型AMD具有一定的有效性.治疗无效的原因可能与CNV活动性强、病灶范围扩大以及病灶位于黄斑中心凹区域内有关.     

Intravitreal ranibizumab for the treatment of choroidal neovascularisation secondary to angioid streaks

Aims

To assess the medium to long-term efficacy and safety of intravitreal ranibizumab for the treatment of choroidal neovascularisation (CNV) secondary to angioid streaks (AS).

Methods

A total of 12 eyes of nine patients treated with intravitreal ranibizumab (0.5 mg in 0.05 ml) for CNV secondary to AS were retrospectively identified. Efficacy of treatment was determined by changes in best-corrected LogMAR visual acuity (BCVA) and optical coherence tomography. Changes with respect to baseline BCVA were defined as improved or reduced with a gain or loss of more than 10 letters, respectively, or stable if remaining within 10 letters.

Results

Over a mean follow-up of 21.75 months (range: 1–54), patients received mean 5.75 (range: 2–15) intravitreal ranibizumab injections per affected eye. BCVA improved in three eyes (25%), stabilised in eight eyes (66.67%), and deteriorated in one eye (8.33%). There was no significant change in central retinal thickness (CRT) over the follow-up period (P=0.1072). No drug-related systemic side effects were recorded.

Conclusion

The long-term treatment of CNV secondary to AS with intravitreal ranibizumab showed a stabilisation in CRT and an improvement or stabilisation of BCVA. The absence of systemic side effects was reassuring. Further long-term prospective studies are required to validate these findings.     

Intravitreal bevacizumab (Avastin) treatment of neovascular age-related macular degeneration

PURPOSE: To report the change in visual acuity and central retinal thickness by optical coherence tomography (OCT) after intravitreal injections of bevacizumab for the treatment of neovascular age-related macular degeneration (AMD). METHODS: A retrospective case series in a university-based practice evaluated patients with subfoveal choroidal neovascularization (CNV) due to AMD. Patients received intravitreal injections (1.25 mg) of bevacizumab and were monitored monthly with determination of best-corrected ETDRS visual acuity and OCT for persistence of retinal thickening. Eyes were retreated on an "as needed" basis, defined by presence of intraretinal or subretinal fluid. Patients were monitored every 2 months to 3 months for persistence of angiographic leakage. RESULTS: Seventy-nine eyes of 74 consecutive patients received the initial injection of bevacizumab between August 1, 2005, and January 30, 2006. Sixty-eight eyes (86%) of 64 patients had at least 3 months of follow-up. Mean central retinal thickness +/- SD decreased from 304 +/- 83 microm at baseline to 237 +/- 105 microm at 3 months (P = 0.00002). Mean ETDRS visual acuity gained 4 letters from 20/100 at baseline to 20/80-1 at 3 months (P = 0.040). Twenty eyes (25%) appeared to have a sustained response to a single injection and did not require further injections through 3 months. Two patients had a potentially drug-related adverse event (ischemic stroke and myocardial infarction). No serious injection-related adverse events occurred. CONCLUSIONS: Intravitreal bevacizumab injection affects a rapid decrease in retinal thickness to normal or near-normal levels and improvement in visual acuity in eyes with CNV due to AMD. The sustainability of changes in retinal thickness and visual acuity in response to bevacizumab treatment warrant further investigation and long-term follow-up.     

Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration

PURPOSE: To evaluate the efficacy of intravitreal injection of bevacizumab combined with photodynamic therapy (PDT) for the treatment of occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (s-PED) due to age-related macular degeneration (AMD). METHODS: In this retrospective study, six patients (six eyes) with subfoveal occult CNV associated with s-PED due to AMD were treated with intravitreal bevacizumab combined with PDT. All patients were treated at baseline with PDT followed by intravitreal bevacizumab 1.25 mg 1 hour later. Afterwards, according to the findings of optical coherence tomography and fluorescein angiography, repeat bevacizumab injections were given, if necessary, monthly for three doses followed by further doses every 3 months. PDT was repeated every 3 months according to the same criteria. Follow-up time was 9 months. RESULTS: All patients completed their treatment during the first 3 months from baseline. Best-corrected visual acuity (BCVA) improved or remained stable related to the baseline values in all patients at the end of the follow-up time. Mean BCVA improved from 20/67 to 20/42. S-PED and subretinal fluid decreased or disappeared. The mean central 1-mm retinal thickness was reduced from baseline value for the 9-month follow-up period by 128 microm. CONCLUSION: Intravitreal bevacizumab combined with PDT seems to be a promising treatment with good functional and anatomical results for occult CNV associated with s-PED due to AMD.     

特发性眼底血管样条纹的临床特征

目的分析特发性眼底血管样条纹的临床特征。方法分析13例（26眼）特发性眼底血管样条纹患者的临床表现、荧光素眼底血管造影（FFA）及黄斑区光学相干断层扫描（OCT）表现。结果11眼视力≤0.3,占42.31%。26眼眼底后极部均可见类似血管样的放射状条纹,5眼为斑驳状外观,占19.23%;17眼条纹通过黄斑,占65.38%;1眼（3.8%）合并眼外伤致多发性脉络膜破裂出血。FFA显示26眼血管样条纹均表现为透见荧光,11眼黄斑区可见脉络膜新生血管（CNV）影,其亮度逐渐增强,后期有明显的荧光素渗漏。黄斑区OCT检查发现11眼有CNV表现。Ⅰ型CNV（生长于RPE光带下）：表现为在隆起的视网膜色素上皮（RPE）和脉络膜毛细血管层光带下有不均匀的中或高反射带;混合型CNV：表现为CNV侵入RPE光带及视网膜神经上皮层下空间,RPE光带中断,呈现边界不清的高反射组织。结论眼底、FFA及OCT典型表现的综合分析有助于特发性眼底血管样条纹的诊断、分期及治疗指导。     

Efficacy of 12‐month treatment of neovascular age‐related macular degeneration with intravitreal bevacizumab based on individually determined injection strategies after three consecutive monthly injections

Purpose: To report the results of intravitreal treatment with bevacizumab in neovascular age‐related macular degeneration (AMD) after a loading dose (LD) of three monthly injections followed by an optical coherence tomography (OCT)‐guided strategy, based on best‐corrected visual acuity (VA) and number of injections required over 1 year. Methods: A series of consecutive cases of 149 eyes of 147 patients received three or more intravitreal injections of bevacizumab (1.25 mg) for neovascular AMD over a 1‐year period. The patients underwent ophthalmological examinations: measurement of the VA, fluorescein angiography, dilated fundus examination at baseline; VA, OCT and dilated fundus examination at monthly follow‐up visits. Repeated injections were given each month for the first 3 months (LD); thereafter, injections were only administered if leakage or macular oedema were present. Results: Mean baseline VA was 51 ± 14 letters, which improved to 58 ± 15 letters (p < 0.0001; n = 149) at first evaluation (15 ± 2 weeks), 59 ± 15 letters (p < 0.0001; n = 143) at second evaluation (25 ± 2 weeks) and 57 ± 16 letters (p < 0.0001; n = 132) at third evaluation (51 ± 3 weeks). The baseline mean central retinal thickness (344.6 μm) and total macular volume (8.6 mm³) decreased at first evaluation, to 219.0 μm (p < 0.0001) and 7.2 mm³ (p < 0.0001), respectively. The mean number of injections per patient treated for 1 year was 5.1 (range 3–9). No systemic side‐effects were noted. Conclusion: Treatment of neovascular AMD with intravitreal bevacizumab administered in LD of three monthly injections and followed by an OCT‐guided strategy provides functional and anatomical improvements for up to 1 year.     

Intravitreal bevacizumab (avastin) for central and hemicentral retinal vein occlusions: IBeVO study

PURPOSE: To evaluate the safety, visual acuity changes, and morphologic effects associated with intravitreal bevacizumab injections for the management of macular edema due to ischemic central or hemicentral retinal vein occlusion (RVO). METHODS: In this prospective, open-label study, 7 consecutive patients (7 eyes) with macular edema associated with ischemic central or hemicentral RVO were treated with intravitreal injections of 2.0 mg (0.08 mL) of bevacizumab at 12-week intervals. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 6, and 12 after each injection. Clinical evidence of toxicity and complications as well as changes in logarithm of minimum angle of resolution Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) shown by optical coherence tomography (OCT), and dye leakage shown by fluorescein angiography were evaluated. RESULTS: The median age of the 7 patients was 65 years (range, 58-74 years), and the median duration of symptoms before injection was 7 months (range, 2.5-16 months). At baseline, mean BCVA was 1.21 (Snellen equivalent, approximately 20/320) in the affected eye. Mean baseline CMT and TMV were 730.1 microm and 17.1 mm(3), respectively. Fluorescein leakage was observed in the macula and affected retinal quadrants in all seven eyes. Six patients completed the 25-week follow-up examination with reinjections performed at weeks 12 and 24. The most common adverse events were conjunctival hyperemia and subconjunctival hemorrhage at the injection site. At the last follow-up, mean BCVA in the affected eye was 0.68 (Snellen equivalent, 20/100(+1). No patient had a decrease in BCVA. Mean CMT and TMV at the 25-week follow-up were 260.3 microm and 9.0 mm(3), respectively; fluorescein leakage within the macula and affected retinal quadrants as compared with baseline was markedly reduced in all patients. Coupled with fluorescein angiographic findings, OCT data suggest a trend of macular edema recurrence between 6 weeks and 12 weeks after injection. CONCLUSIONS: Intravitreal bevacizumab injections of 2.0 mg at 12-week intervals were well tolerated and were associated with short-term BCVA stabilization or improvement and favorable macular changes in all patients with ischemic RVO and associated macular edema.     

Combined therapy with bevacizumab and photodynamic therapy for myopic choroidal neovascularization:A one-year follow-up controlled study

AIM: To evaluate the efficacy and safety of a combined treatment for myopic choroidal neovascularization (CNV) using photodynamic therapy (PDT) and intravitreal bevacizumab and to compare it with intravitreal bevacizumab monotherapy.METHODS: Thirty-four eyes with angiographic evidence of myopic CNV were randomly divided into two groups:17 were treated with one intravitreal bevacizumab injection (1.25 mg) and low-fluence-rate PDT within seven days of the injection (Group A). The other 17 received monotherapy with bevacizumab injections (Group B). Clinical evidence of complications, best corrected visual acuity (BCVA) and fluorescein leakage were evaluated. BCVA and optical coherence tomography (OCT) were evaluated monthly. The timepoints follow-up was established at 6 and 12mo. All patients were retreated following a PRN protocol.RESULTS:A total of 34 eyes of 34 patients (26 women and 8 men) with a mean age of 62.35 years were included. In Group A (17 eyes) the mean BCVA increased from 0.55±0.13 logMAR before the treatment to 0.40±0.09 logMAR at the 12mo follow-up (P<0.01). In Group B (17 eyes) the mean BCVA increased from 0.60±0.11 logMAR before the treatment to 0.55±0.12 logMAR at the 12mo follow-up (P<0.01). There was no statistically significant difference between the two groups in terms of LogMar visual acuity. In Group A the mean number of combined treatments was 1.8±0.11 per patient; in Group B the mean number of intravitreal bevacizumab injections was 3.1±0.08 per patient. The number of treatments was significantly fewer in Group A (P<0.01). No local or systemic side effects occurred among any of the patients treated in this study.CONCLUSION:The combination of anti-angiogenic injections and PDT appears to be a safe and effective option for myopic CNV treatment and allows for a significant reduction of intravitreal injections.     

Intravitreal Ranibizumab for Treatment of Choroidal Neovascularization Secondary to Angioid Streaks in Pseudoxanthoma Elasticum: Five-year Follow-up

Purpose: To report on the five-year follow-up of ranibizumab therapy for choroidal neovascularization (CNV) secondary to angioid streaks (AS) in pseudoxanthoma elasticum (PXE).

Methods: A 51-year-old patient with PXE presenting with macular CNV secondary to AS was treated with a series of intravitreal ranibizumab (0.5 mg) injections and followed for five years with fundoscopy, optical coherence tomography (OCT), and fluorescein angiography (FA).

Results: Fluorescein leakage resolved and OCT evidence of subretinal and intraretinal fluid disappeared one year after presentation following an initial 12 injections. There was mild recurrent neovascular activity on two occasions resulting in two injections in the four years subsequent to resolution. Though peripapillary scar formation occurred, the fovea was preserved with 20/20 visual acuity in the affected eye at five years.

Conclusions: This case provides further evidence for the long-term effectiveness of ranibizumab in the treatment of CNV secondary to AS in PXE. Though multiple initial injections were required to control the disease, once stabilization of the CNV was achieved, recurrent neovascular activity was minimal.