Retinal pigment epithelial tear following intravitreal injection of bevacizumab (Avastin)

PURPOSE: To report one case of retinal pigment epithelium tear following intravitreal bevacizumab injection for neovascular age-related macular degeneration. METHODS: A 59-year-old patient presented with occult choroidal neovascularization associated with a serous pigment epithelial detachment secondary to age-related macular degeneration. The patient was treated with an intravitreal injection of bevacizumab. RESULTS: The patient developed a retinal pigment epithelium tear 60 days following the intravitreal injection. CONCLUSIONS: This report describes the development of retinal pigment epithelium tear after intravitreal bevacizumab injection. Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this potential devastating visual complication.     

Intravitreal bevacizumab for treatment of refractory central serous choroidoretinopathy

In a clinical case series, 5 patients with not-resolved central serous choroidoretinopathy (CSC) lasting more than 1 year received one intravitreal bevacizumab injection (IVB, 1.25 mg) injection. All patients underwent a through ophthalmic examination 1 day, 1 week, and 1, 2, and 6 months after the injection. Best corrected visual acuity (BCVA) and central macular thickness were compared before and after treatment by optical coherence tomography. Mean BCVA was improved significantly (p = 0.020) from 0.60 ± 0.25 to 0.50 ± 0.18 and 0.29 ± 0.19 logarithm of minimum angle of resolution at 6 and 18 weeks, respectively. Central macular thickness was also decreased significantly (p = 0.010) from 370 ± 65 to 208 ± 23 μm at 4 months. No recurrence was occurred during follow-up. IVB injection may have beneficial effect in the treatment of refractory CSC.     

Intravitreal Bevacizumab for Photodynamic Therapy-Induced Massive Macular Detachment in Acute Central Serous Chorioretinopathy

We present a long followed up case of acute central serous chorioretinopathy (CSC) complicated by a severe visual loss due to massive pigment epithelium detachment of the macula after a full-dose photodynamic therapy (PDT). Rapid anatomical and functional improvement was observed after a single intravitreal injection of bevacizumab. To our knowledge, we report the first case of PDT-treated CSC complicated by severe visual loss. We can only speculate that the serous detachment of the posterior pole might have been caused by PDT-induced VEGF overexpression, explaining such an impressive response to Avastin treatment.Key Words: Bevacizumab, Central serous chorioretinopathy, Photodynamic therapy     

Therapieoption bei chronischer Chorioretinopathia centralis serosa

Background

This article reports about the use of a combined photodynamic therapy (PDT) and intravitreal injection of bevacizumab as a treatment option in nine patients with chronic central serous chorioretinopathy (CSC).

Patients and methods

A total of nine male patients with chronic CSC were treated with standard PDT laser treatment with verteporfin and intravitreal injection of bevacizumab administered within 24?h. Before and 1, 3, 6, 9 and 12 months after treatment the results of visual acuity, fluorescein angiography (FA) and optical coherence tomography (OCT) examinations were documented.

Results

All patients showed an improvement in visual acuity of 1?C4 ETDRS lines. Mean visual acuity increased from baseline 20?/?40 to 20?/?25 after 3 months. FA and OCT findings showed a restitution of leakages and subretinal fluid in all cases. After 6?C12 months follow-up 8 patients had ongoing improvement in vision without recurrence of CSC.

Conclusion

The combination of PDT with bevacizumab in this case series appears to be an effective and safe therapy combination which is suitable as a therapeutic option for patients with chronic CCS without a tendency to recovery.     

Serous Retinal Detachment Following Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection

We report a case of serous retinal detachment following combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in subfoveal choroidal neovascularization (CNV).A 53-year-old woman was diagnosed with subfoveal CNV secondary to age-related macular degeneration (AMD) and treated with combined PDT and intravitreal bevacizumab injection. One day after treatment, the patient experienced a sudden decline of vision and optical coherence tomography (OCT) showed serous retinal detachment involving the macula. She was managed conservatively with an oral steroid beginning on the second day of the combined treatment and the subretinal fluid started to decrease one week following the initiation of steroids.This case suggests that combined PDT and intravitreal injection of bevacizumab can be associated with serous retinal detachment. Additional studies are needed to establish the safety and complications following this treatment regimen.     

A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (Case reports)

BACKGROUND: We report the use of intravitreal bevacizumab as a new option in the treatment of central serous chorioretinopathy (CSC). METHODS: Five eyes with retinal pigment epithelium (RPE) leaks secondary to CSC received intravitreal bevacizumab (2.5 mg/0.1 cc), and underwent best corrected visual acuity, fluorescein angiography and optical coherent tomography before, 1, 3 and 6 months after treatment. RESULTS: All patients showed improvement in visual acuity, fluorescein angiographic leakage, and reduced or resolved neurosensory detachment following treatment. CONCLUSIONS: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.     

Multifocal electroretinogram findings after intravitreal bevacizumab injection in choroidal neovascularization of age-related macular degeneration

Purpose

To evaluate the changes in multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) after intravitreal bevacizumab injection in the treatment of age-related macular degeneration (AMD).

Methods

Twenty-one eyes with choroidal neovascularization secondary to AMD were studied before and after intravitreal bevacizumab injection for best corrected visual acuity (BCVA), OCT, and mfERG.

Results

The BCVA improved, while central macular thickness and total macular volume in OCT decreased after intravitreal bevacizumab injection (p = 0.03, 0.01, and 0.01, respectively). In mfERG, the amplitude of P1, and implicit time of P1 and N1 indicated a statistically significant improvement of retinal response after intravitreal bevacizumab injection.

Conclusions

There is a potential role for mfERG in evaluating the effect on retinal function of intravitreal bevacizumab injection.     

Chorioretinopathia centralis serosa (CCS)

In the acute stage central serous chorioretinopathy (CSC) is characterized by serous retinal detachment. Monofocal or multifocal structural changes of the pigment epithelium layer are common. Unilateral blurred vision is the major clinical symptom. The pathogenesis is unclear but corticosteroids and stress may trigger the disease. Normal vision often returns spontaneously within a few months. Therapeutic options are at a low evidence level. Carbonic anhydrase, mild laser photocoagulation, selective retinal therapy, photodynamic therapy and the intravitreal injection of bevacizumab have been reported. The authors suggest a treatment strategy on the basis of the available data.     

Atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy: case reports

ABSTRACT: BACKGROUND: To report two cases of atypical vitelliform macular dystrophy misdiagnosed as chronic central serous chorioretinopathy. CASE PRESENTATION: Two patients with incidentally discovered abnormalities of the retina without specific symptoms were referred to our hospital for consultation. Bilateral macula atrophic lesions were observed and optical coherence tomography revealed serous retinal detachment in the macula. Fluorescein angiography showed multiple leakages around the central hypofluorescent area and indocyanine green angiography showed partially dilated choroidal vessels. Fundus autofluorescence (FAF) showed a decreasing pattern of autofluorescence in the subretinal fluid area, and increasing autofluorescence at the border of the serous retinal detachment. Both patients were diagnosed with chronic central serous chorioretinopathy. Photodynamic therapy and intravitreal bevacizumab injection were administered for engorged choroidal vessels during follow-up, but neither patient showed improvement in symptoms or ophthalmologic findings. Based on re-evaluation by fundus photography, optical coherence tomography, fluorescein angiography, and comparison of the results of FAF with the first visit, vitelliform macular dystrophy was suspected and a definite diagnosis was made by electrooculography and genetic testing. CONCLUSION: In patients with continuous serous retinal detachment without response to photodynamic therapy or intravitreal bevacizumab injection, careful fundus exam and FAF can be used to diagnose atypical vitelliform macular dystrophy.     

Electrophysiologic findings after intravitreal bevacizumab (Avastin) treatment

PURPOSE: To evaluate the short-term electrophysiologic effects of intravitreal bevacizumab in the treatment of exudative age-related macular degeneration (AMD). METHODS: Nine subjects with AMD who received treatment with intravitreal bevacizumab for exudative AMD underwent pretreatment testing with multifocal electroretinography (mf-ERG) or Ganzfeld electroretinography (G-ERG). All five G-ERG subjects underwent repeated testing at 1 week after intravitreal bevacizumab. All four mf-ERG subjects and four of the five G-ERG subjects underwent repeated testing with the same pretreatment protocol at 1 month after treatment. One G-ERG subject also received a second intravitreal injection of bevacizumab at 6 weeks after initial treatment and underwent repeated testing at 1 month after the second dose (3 months after initial treatment). RESULTS: All four subjects undergoing mf-ERG had improvement of the macular response at 1 month of after treatment. The average improvement in response density of the central 15 degrees of macular response was 35% (range, 11-65%). Subjects undergoing G-ERG testing had no significant changes in electrophysiologic response, although some variation in amplitude and implicit time was noted at different testing times. Optical coherence tomography central subfield thickness decreased from 298 microm at baseline to 274 microm at 1 month after treatment. Visual acuity improved in a majority of subjects. CONCLUSION: In this study, the intravitreal use of bevacizumab resulted in improvement of mf-ERG macular function responses and relatively stable G-ERG responses. The macular electrophysiologic response suggests that macular function improves with treatment. G-ERG suggests that there is no significant measurable photoreceptor toxicity with the use of intravitreal bevacizumab over the short term.     

玻璃体腔注射贝伐单抗治疗慢性CSC的长期疗效观察

目的：探讨玻璃体腔注射贝伐单抗(IVB)治疗慢性中心性浆液性脉络膜视网膜病变(central serous chorioretinopathy,CSC)的安全性和长期临床疗效。

方法：我们给予6例6眼慢性CSC患者玻璃体腔注射1.25mg/0.05mL IVB治疗。5例患者在第一次注射后3mo接受了第二次相同剂量的注射。注射后1,3,6,12,24mo时随访观察。观察指标包括治疗前后的最佳矫正视力、眼压、OCT、眼底荧光素造影(FFA)。

结果：第一次玻璃体腔注射IVB后,2例患者视网膜下液(SRF)完全吸收,但其中1例在随访至3mo复发; 3例患者SRF有小幅度上升或下降; 1例患者的SRF先上升后明显下降; 再次进行IVB后,3例患者SRF完全吸收,其他的3例患者SRF无明显变化。但是SRF的吸收与视力的变化并不是同步的。治疗前后1,2a患者的视力变化在统计学上没有显著性差异。随访期间所有患者眼压均在正常范围,无一例出现眼内炎。

结论：玻璃体腔注射IVB对于治疗慢性CSC患者是安全的,对促进SRF的吸收有一定效果,但从长期结果来看,IVB对于慢性CSC患者的远期视力预后无明显作用。     

Retinal pigment epithelium tears after intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration

BACKGROUND: Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab. METHODS: In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate. RESULTS: Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%. CONCLUSIONS: RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.     

Intravitreal Bevacizumab Treatment of Macular Edema Due to Optic Disc Vasculitis

Purpose: To report the efficacy of intravitreal bevacizumab injection in treatment of macular edema in a case of optic disc vasculitis. Design: Retrospective case review. Methods: A patient diagnosed with macular edema due to optic disc vasculitis was treated with intravitreal bevacizumab injection. Results: One week after injection, fundus appearance dramatically improved and macular edema regressed. The patient was followed up for 1 year after injection and there was no recurrence of macular edema. Conclusions: This case suggests that intravitreal bevacizumab treatment might be effective in the management of macular edema in patients with optic disc vasculitis.     

The efficacy of intravitreal bevacizumab for idiopathic central serous chorioretinopathy

Background  

To evaluate the efficacy of intravitreal bevacizumab injection in the treatment of central serous chorioretinopathy (CSC).     

玻璃体腔注射Bevacizumab联合PDT治疗CSC

目的：研究玻璃体腔注射bevacizumab联合PDT治疗中心性浆液性视网膜脉络膜病变(central serous choroiretinopathy, CSC)患者的临床疗效。

方法：选取2012-02/2015-04于我院就诊的CSC患者82例82眼作为研究对象,所有患者均经OCT、FFA确诊,且均为单眼患病。按治疗方法不同将所有患者分为对照组35例35眼和研究组47例47眼。其中对照组患者采用光动力(PDT)治疗,研究组患者采用PDT联合玻璃体腔内注射bevacizumab治疗。对比两组患者治疗次数、浆液性色素上皮脱离(PED)平伏率和黄斑视网膜下液、黄斑中心区直径的总体积、黄斑中心区直径6mm的平均厚度和黄斑中心区1mm范围的厚度等OCT指标,以及治疗前后不同时间最佳矫正视力和临床疗效。

结果：对照组患者中32眼治疗1次,3眼治疗2次,平均治疗次数为1.25±0.20次; 研究组中9眼治疗3次,10眼治疗2次,28眼治疗1次,平均治疗次数1.48±0.22次。两组患者治疗次数对比差异无统计学意义(t=1.209,P>0.05)。对照组患者PED平伏13眼(37%),黄斑视网膜神经上皮下浆液吸收22眼(63%)。研究组患者PED平伏30眼(64%),黄斑视网膜神经上皮下浆液吸收17眼(36%)。两组患者治疗后PED平伏率和黄斑视网膜神经上皮下浆液吸收率对比均差异均有统计学意义(P<0.05)。两组患者治疗前黄斑中心区直径的总体积、黄斑中心区直径6mm的平均厚度和黄斑中心区1mm范围的厚度等OCT指标对比差异无统计学意义(P>0.05),而治疗后研究组患者在这些OCT指标上均明显低于对照组,且差异均有统计学意义(P<0.05)。两组患者治疗后在这些OCT指标均明显低于各组治疗前,且均有统计学意义(P<0.05)。两组患者治疗前和治疗后1mo最佳矫正视力对比差异无统计学意义(P>0.05),治疗后3、6mo时研究组患者最佳矫正视力(LogMAR)明显低于对照组,且差异均有统计学意义(P<0.05)。对照组患者中无效6眼,好转15眼,显效8眼,治愈6眼,总有效率为83%; 研究组患者中无效3眼,好转8眼,显效20眼,治愈16眼,总有效率为94%,两组患者总有效率对比差异有统计学意义(P<0.05)。

结论：在慢性CSC合并PED患者治疗中玻璃体注射抗VEGF单克隆抗体bevacizumab联合低剂量PDT在平伏PED,促进黄斑视网膜下浆液吸收,降低黄斑视网膜厚度,改善视力方面优于单一PDT治疗患者。     

Intravitreous injection of bevacizumab for chronic central serous chorioretinopathy

Background/PurposeTo evaluate the effect of intravitreal bevacizumab on subretinal fluid absorption in patients with chronic central serous chorioretinopathy (CSCR).Materials and methodsThis was a retrospective case series study. Patients with CSCR symptoms for > 3 months and who received intravitreal injection of bevacizumab were included. Ocular examinations were carried out at baseline and every follow-up visit, including visual acuity, fundus examination, and optic coherence tomography.ResultsTwelve eyes in 12 patients were included in this study. One month after injection, three of the 12 patients who had increased central macular thickness were considered nonresponders. Nine of the 12 patients who had decreased central macular thickness were considered to have responded to intravitreal bevacizumab injection. The response rate was 75%. In the response group, the mean central macular thickness significantly decreased, from 306.7 ± 77.8 μm to 204.3 ± 59.3 μm (p = 0.001) at 1 month. The mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity was significantly improved from 0.72 ± 0.35 to 0.50 ± 0.28 (p = 0.008). Six of these nine patients had stable conditions lasting > 6 months. Three of them had recurrence.ConclusionIntravitreal bevacizumab injections improved subretinal fluid absorption in some patients with CSCR. It could be an alternative therapy for patients with CSCR, especially when they are not suitable for other treatments.     

Rapid response to intravitreal aflibercept in neovascular age-related macular degeneration after development of tachyphylaxis to bevacizumab and ranibizumab

This article reports a rapid response of intravitreal aflibercept for the treatment of a case of neovascular age-related macular degeneration that developed tachyphylaxis to bevacizumab and ranibizumab. An 80-year-old man with neovascular age-related macular degeneration became unresponsive to monthly treatment with bevacizumab or ranibizumab after initial responsiveness, to as-needed treatment with these antivascular endothelial growth factor drugs for 49 months. Subretinal fluid and pigment epithelial detachment had sustained in spite of 14 bevacizumab and seven ranibizumab injections prior to intravitreal aflibercept treatment. After only one injection of intravitreal aflibercept, a marked improvement was seen within 1 week. Complete drying of subretinal fluid and marked subsidence of pigment epithelial detachment were noted 4 weeks after the first aflibercept injection and sustained for three consecutive monthly injections. This case reveals that shifting to aflibercept may be an effective alternative treatment for neovascular age-related macular degeneration that becomes tachyphylactic to bevacizumab or ranibizumab.     

Bevacizumab intravítreo como tratamiento de las telangiectasias yuxtafoveales idiopáticas tipo i

Clinical caseWe report a case of a 42 year-old male with a macular edema due to idiopathic juxtafoveal retinal telangiectasis type i, treated with 3 sequential injections of intravitreal bevacizumab (1.25 mg in 0.05 ml). Anatomical improvements were observed after one year of follow up.DiscussionThere is currently no general consensus regarding the treatment of unilateral idiopathic juxtafoveal telangiectasis. The therapeutic options are, grid laser photocoagulation, intravitreal triamcinolone, verteporfin photodynamic therapy, or anti-VEGF. Visual acuity and anatomical improvements were observed in this case after intravitreal bevacizumab. Thus, intravitreal bevacizumab seems to be effective to treat macular edema in idiopathic juxtafoveal telangiectasis type i.     

Retinal pigment epithelial tear after intravitreal bevacizumab injection

PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). DESIGN: Observational case series. METHODS: Two patients presented with occult choroidal neovascularization secondary to AMD. Both patients received intravitreal bevacizumab injections. RESULTS: The first patient developed a RPE tear shortly after a third intravitreal bevacizumab injection. The second patient developed a RPE tear 10 days after a second intravitreal bevacizumab injection. CONCLUSIONS: Although RPE tears may occur spontaneously as part of the natural history of exudative AMD, patients may develop visually devastating RPE tears after repeat intravitreal bevacizumab injection. Further studies are needed to determine the incidence of RPE tears after intravitreal bevacizumab injections.     

Intraocular bevacizumab for macular edema due to CRVO. A multifocal-ERG and OCT study

Purpose To evaluate by multifocal electroretinography (MFERG) and optical coherence tomography (OCT) the effectiveness of intravitreal use of bevacizumab (Avastin) in the treatment of macular edema due to central retinal vein occlusion (CRVO). Methods A total of 10 eyes of 10 patients (six males and four females) with macular edema due to CRVO were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow-up was 3 months. Examination included measurement of best-corrected visual acuity (BCVA) for distance, measurement of intraocular pressure (IOP), fluorescein angiography, foveal-retinal thickness measurement by OCT, and MFERG recordings before treatment and 1 and 3 months after treatment. Results Before treatment, OCT shows an increase of the retinal thickness of the fovea. About 1 and 3 months after treatment the foveal thickness decreased to a significant level. The electrical responses in the fovea and parafovea of the MFERG recording depicted a significant improvement at 1 and 3 months after the injection. No patient manifested IOP increase. Conclusion The intravitreal use of bevacizumab may provide anatomical and functional amelioration of the macula in patients with macular edema due to CRVO. However, further study is needed in order to assess the treatment’s long-term efficacy.