Use of intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to choroidal rupture

Case reportA 28 year-old male attended our Emergency Department with a traumatic choroidal rupture and macular haemorrhage. After pneumatic displacement of the haemorrhage with C₃F₈ and tissue plasminogen activator, the haemorrhage was reabsorbed and visual acuity (VA) improved. Three months later the patient presented with decreased VA and a juxtafoveal choroidal neovascularisation (CNV) that was treated with intravitreal bevacizumab. One year after a single bevacizumab injection the CNV remained inactive, with a final VA of 0.5.DiscussionIntravitreal bevacizumab injection is a new and effective treatment for traumatic CNV. In our patient, in contrast to other aetiologies, the CNV needed no more than one Avastin^® injection to be inactivated, after one year of follow-up.     

Failure of intravitreal bevacizumab in the treatment of choroidal metastasis

Background

Metastasis to choroid is the most common intraocular malignancy, arising most frequently from carcinoma of breast in women and lung in men. Recent case reports have described successful use of intravitreal bevacizumab to achieve local control of such tumours.

Materials and methods

Five cases of choroidal metastases from varying primaries: breast, lung, and colon were treated with intravitreal bevacizumab, and tumour response observed and documented with serial photographs and B-scans.

Results

Four of the five tumours were seen to progress despite intravitreal bevacizumab treatment.

Conclusions

Intravitreal bevacizumab as the primary treatment of choroidal metastases is not recommended and should not delay more effective alternative treatments.     

Regression of choroidal metastasis from breast carcinoma following Letrozole therapy

Metastasis to the choroid from primary tumours elsewhere in the body is not an infrequent occurrence. Management of such metastasis may involve modalities such as radiotherapy, chemotherapy, photocoagulation and surgical resection. The role of hormonal therapy is poorly defined in the management of these tumours. Herein regression of choroidal metastasis from primary breast carcinoma following antihormonal therapy with the antioestrogen drug Letrozole is reported.     

Regression of late onset choroidal metastasis from a breast carcinoma with letrozole

We report the case of a 50-year-old woman with a history of diabetes mellitus who underwent left breast lumpectomy and ipsilateral lymphadenectomy in 1994 because of an infiltrating ductal carcinoma. Chemotherapy followed by radiotherapy to the breast and nodal areas were performed. In 2010, in a routine screening for diabetic retinopathy, two choroidal elevated masses above and below the optic nerve associated to serous retinal detachment of her right eye were noted. The patient was asymptomatic. Carcinoma was positive for hormone receptor. Hormone treatment with letrozole was established. Complete regression of the choroidal metastasis was observed 3 months later. Ophthalmologic screening in asymptomatic patients with breast cancer has the advantage of being a noninvasive procedure and enables an early treatment in isolated cases. However, some studies are an argument against the usefulness of eye screening due to the low incidence of asymptomatic choroidal metastasis and the cost that involves performing it routinely in a large number of patients. Aromatase inhibitors are well-tolerated drugs that may be a powerful tool in the management of metastatic breast cancer that express hormone receptors.     

Treatment of polypoidal choroidal vasculopathy by intravitreal injection of bevacizumab

Purpose  

To evaluate the efficacy of intravitreal bevacizumab (IVB) in eyes with polypoidal choroidal vasculopathy (PCV).     

Extrafoveal choroidal neovascularization secondary to wet age-related macular degeneration treated with intravitreal bevacizumab.

Considering the risk of recurrence of extrafoveal or juxtafoveal lesions after thermal laser treatment and the risk of poor response to photodynamic therapy, it seems reasonable to discuss with the patient the risks and benefits of antiangiogenic therapy. A case of age-related macular degeneration with an extrafoveal choroidal neovascularization treated with a single injection of intravitreal bevacizumab is described. The patient showed both anatomic and visual acuity improvement at 1 month following treatment that persisted even at the 8-month follow-up visit. Further studies are needed to validate the real risk-benefit ratio of intravitreal bevacizumab for extrafoveal exudative lesions versus the current treatments available.     

Dramatic response of choroidal neovascularization associated with choroidal osteoma to the intravitreal injection of bevacizumab (Avastin)

PURPOSE: To report the dramatic response of juxtafoveal choroidal neovascularization (CNV) associated with choroidal osteoma to a single intravitreal injection of bevacizumab. METHODS: A 19-year-old female presented with decreased visual acuity and metamorphopsia in her right eye. Best corrected visual acuity assessment, ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and high-resolution computed tomography (CT) scan of the orbit was performed. A diagnosis of classic juxtafoveal CNV associated with choroidal osteoma was made. Intravitreal injection of 1.25 mg of bevacizumab was performed. RESULTS: Visual acuity of the right eye was 20/200 before treatment. Visual improvement to 20/25 and the resolution of metamorphopsia was noticed six weeks after the intravitreal injection of bevacizumab. Regression of the CNV was confirmed according to ophthalmoscopic, fluorescein angiographic, and OCT findings. The treatment effect persisted during a 9-month follow-up period. CONCLUSION: The intravitreal injection of bevacizumab can result in the rapid regression of CNV secondary to choroidal osteoma.     

玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管

目的:观察玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管(CNV)的临床疗效和安全性.方法:回顾分析临床确诊为病理性近视CNV患者24例25眼,所有患者行ETDRS视力表检查、前置镜下眼底检查、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、光学相干断层扫描(OCT)检查.所有患者按照常规内眼手术操作要求玻璃体腔内注射lOmg/mL雷珠单抗0.05mL,随访4～lOmo.观察比较治疗前后最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT).结果:所有患者均未出现与治疗相关的局部和全身并发症.平均治疗次数为1.52次.治疗前最佳矫正视力(BCVA)平均23.93±12.46个字母;末次随访BCVA平均40.63 ±7.25个字母,较治疗前提高14.27±9.36个字母,差异有统计学意义(t=5.74,P＜0.05).治疗前CMT平均363.47±119.62μm,末次随访平均CMT为190.31±37.02μm,较治疗前下降72.82±60.57μm,差异有统计学意义(t=3.96,P＜0.05).结论:玻璃体腔注射雷珠单抗治疗病理性近视CNV是安全有效的,有利于提高患者视力,减轻视网膜水肿,停止或减少病灶的渗漏.     

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.