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Bevacizumab in retinal vein occlusion-results of a prospective case series

  • Andreas Stahl
  • Hansjürgen Agostini
  • Lutz L. Hansen
  • Nicolas FeltgenEmail author
Clinical Investigation

Abstract

Background

Macular edema is the main reason for decreased visual acuity (VA) in early retinal vein occlusion (RVO). Bevacizumab (Avastin, Genentech) is an anti-VEGF substance to treat macular edema triggered by hypoxia-induced expression of vascular endothelial growth factor (VEGF). Initial reports showed a significant reduction of central retinal thickness and improved visual acuity (VA) after bevacizumab injection. To date, only retrospective studies and case reports have been published on bevacizumab treatment of RVO.

Methods

In this prospective interventional case series, we evaluated the response to a single bevacizumab treatment in 21 RVO patients (14 CRVO, 7 BRVO). Study endpoints were visual acuity (VA) using ETDRS charts and central macular edema (CME) over 9 weeks.

Results

Mean VA from all 21 patients increased by more than 2 lines (2.4±0.4 lines; p<0.01 compared to baseline). The improvement of VA after bevacizumab injection was concordant with a decrease in central retinal thickness. Peak VA was reached between 3 and 6 weeks after injection. Between week 6 and 9 a decrease in VA was observed. This VA decrease was precipitated by an increase in CME between week 3 and 6. In subgroup analyses, patients receiving bevacizumab injection within the first 3 months after RVO showed an average VA gain of 4 lines (range 2–7 lines) compared to an average gain of 1.8 (range 1–3) and 2.5 (range 1–7) in patients receiving bevacizumab between 4–6 months and after more than 6 months, respectively.

Conclusions

Bevacizumab injection is able to improve CME and VA in RVO patients within the first 3 to 9 weeks. We did not observe any short-term adverse effects during our study. As the decrease in VA was anticipated by an increase in central retinal thickness, regular OCT examinations between week 3 and 6 may be helpful for judging the appropriate timing for re-injection in order to maintain patients within the initially reached range of VA until a new balance between inflow and outflow in the retinal circulation is reached.

Keywords

Bevacizumab Avastin Retinal vein occlusion Macular edema Intravitreal injection 

References

  1. 1.
    Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487PubMedCrossRefGoogle Scholar
  2. 2.
    Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. J Ophthalmol 98:271–282Google Scholar
  3. 3.
    Branch Vein Occlusion Study Group (1986) Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein occlusion. A randomized clinical trial. Arch Ophthalmol 104:34–41Google Scholar
  4. 4.
    Chen HC, Wiek J, Gupta A, Luckie A, Kohner EM (1998) Effect of isovolaemic haemodilution on visual outcome in branch retinal vein occlusion. Br J Ophthalmol 82:162–167PubMedGoogle Scholar
  5. 5.
    The Central Vein Occlusion Study Group (1995) Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. M report. Ophthalmology 102:1425–1433Google Scholar
  6. 6.
    The Central Vein Occlusion Study Group (1995) A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. N report. Ophthalmology 102:1434–1444Google Scholar
  7. 7.
    Glacet-Bernard A, Zourdani A, Milhoub M, Maraqua N, Coscas G, Soubrane G (2001) Effect of isovolemic hemodilution in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 239:909–914PubMedGoogle Scholar
  8. 8.
    Goff MJ, Jumper JM, Yang SS, Fu AD, Johnson RN, McDonald HR, Ai E (2006) Intravitreal triamcinolone acetonide treatment of macular edema associated with central retinal vein occlusion. Retina 26:896–901PubMedCrossRefGoogle Scholar
  9. 9.
    Green WR, Chan CC, Hutchins GM, Terry JM (1981) Central retinal vein occlusion: a prospective histopathologic study of 29 eyes in 28 cases. Retina 1:27–55PubMedGoogle Scholar
  10. 10.
    Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248PubMedCrossRefGoogle Scholar
  11. 11.
    Gregori NZ, Rosenfeld PJ, Puliafito CA, Flynn HW Jr, Lee JE, Mavrofrides EC, Smiddy WE, Murray TG, Berrocal AM, Scott IU, Gregori G (2006) One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion. Retina 26:889–895PubMedCrossRefGoogle Scholar
  12. 12.
    Hansen LL, Danisevskis P, Arntz HR, Hovener G, Wiederholt M (1985) A randomised prospective study on treatment of central retinal vein occlusion by isovolaemic haemodilution and photocoagulation. Br J Ophthalmol 69:108–116PubMedGoogle Scholar
  13. 13.
    Hansen LL, Wiek J, Arntz R (1988) [Randomized study of the effect of isovolemic hemodilution in retinal branch vein occlusion]. [German]. Fortschritte der Ophthalmologie 85:514–516PubMedGoogle Scholar
  14. 14.
    Hansen LL, Wiek J, Schade M, Muller-Stolzenburg N, Wiederholt M (1989) Effect and compatibility of isovolaemic haemodilution in the treatment of ischaemic and non-ischaemic central retinal vein occlusion. Ophthalmologica 199:90–99PubMedCrossRefGoogle Scholar
  15. 15.
    Hansen LL, Wiek J, Wiederholt M (1989) A randomised prospective study of treatment of non-ischaemic central retinal vein occlusion by isovolaemic haemodilution. Br J Ophthalmol 73:895–899PubMedGoogle Scholar
  16. 16.
    Ip MS, Gottlieb JL, Kahana A, Scott IU, Altaweel MM, Blodi BA, Gangnon RE, Puliafito CA (2004) Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. Arch Ophthalmol 122:1131–1136PubMedCrossRefGoogle Scholar
  17. 17.
    Iturralde D, Spaide RF, Meyerle CB, Klancnik JM, Yannuzzi LA, Fisher YL, Sorenson J, Slakter JS, Freund KB, Cooney M, Fine HF (2006) Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina 26:279–284PubMedCrossRefGoogle Scholar
  18. 18.
    Jaissle GB, Szurman P, Bartz-Schmidt KU (2004) Ocular side effects and complications of intravitreal triamcinolone acetonide injection. Ophthalmologe 101:121–128PubMedCrossRefGoogle Scholar
  19. 19.
    Jaissle GB, Ziemssen F, Petermeier K, Szurman P, Ladewig M, Gelisken F, Volker M, Holz FG, Bartz-Schmidt KU (2006) [Bevacizumab for treatment of macular edema secondary to retinal vein occlusion]. Ophthalmologe 103:471–475PubMedCrossRefGoogle Scholar
  20. 20.
    Jonas JB, Kreissig I, Degenring RF (2002) Intravitreal triamcinolone acetonide as treatment of macular edema in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 240:782–783PubMedCrossRefGoogle Scholar
  21. 21.
    Kalogeropoulos C, Donati G, Pizzolato GP, Pournaras CJ (1996) [Morphology of early retinal lesions after experimental venous occlusion]. Klin Monatsbl Augenheilkd 208:375–376PubMedCrossRefGoogle Scholar
  22. 22.
    Krepler K, Ergun E, Sacu S, Richter-Muksch S, Wagner J, Stur M, Wedrich A (2005) Intravitreal triamcinolone acetonide in patients with macular oedema due to branch retinal vein occlusion: a pilot study. Acta Ophthalmol Scand 83:600–604PubMedCrossRefGoogle Scholar
  23. 23.
    Larsson J, Bauer B, Andreasson S (2000) The 30-Hz flicker cone ERG for monitoring the early course of central retinal vein occlusion. Acta Ophthalmol Scand 78:187–190PubMedCrossRefGoogle Scholar
  24. 24.
    Moshfeghi AA, Puliafito CA (2005) Pegaptanib sodium for the treatment of neovascular age-related macular degeneration. Expert Opin Investig Drugs 14:671–682PubMedCrossRefGoogle Scholar
  25. 25.
    Patel PJ, Zaheer I, Karia N (2006) Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion. Eye (in press)Google Scholar
  26. 26.
    Ramezani A, Entezari M, Moradian S, Tabatabaei H, Kadkhodaei S (2006) Intravitreal triamcinolone for acute central retinal vein occlusion; a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol (in press)Google Scholar
  27. 27.
    Rosenfeld PJ, Fung AE, Puliafito CA (2005) Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 36:336–339PubMedGoogle Scholar
  28. 28.
    Rosenfeld PJ, Moshfeghi AA, Puliafito CA (2005) Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging 36:331–335PubMedGoogle Scholar
  29. 29.
    T.C.V.O.S.G (1997) Natural history and clinical management of central retinal vein occlusion. The Central Vein Occlusion Study Group. Arch Ophthalmol 115:486–491Google Scholar
  30. 30.
    Takahashi K, Muraoka K, Kishi S, Shimizu K (1998) Formation of retinochoroidal collaterals in central retinal vein occlusion. Am J Ophthalmol 126:91–99PubMedCrossRefGoogle Scholar
  31. 31.
    Wolf S, Arend O, Bertram B, Remky A, Schulte K, Wald KJ, Reim M (1994) Hemodilution therapy in central retinal vein occlusion. One-year results of a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 232:33–39PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andreas Stahl
    • 1
  • Hansjürgen Agostini
    • 1
  • Lutz L. Hansen
    • 1
  • Nicolas Feltgen
    • 1
    Email author
  1. 1.Department of OphthalmologyUniversity of FreiburgFreiburgGermany

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