Article

Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Miami, Florida, USA.
Ophthalmic Surgery Lasers and Imaging (Impact Factor: 1.46). 01/2005; 36(4):336-9.
Source: PubMed

ABSTRACT To determine whether bevacizumab could improve visual acuity and optical coherence tomography outcomes in a patient with macular edema from central retinal vein occlusion, an intravitreal injection of bevacizumab (1.0 mg) was given. Prior intravitreal injections of triamcinolone acetonide resulted in vision improvement but worsening cataract and borderline glaucoma. Within 1 week of the bevacizumab injection, visual acuity improved from 20/200 to 20/50 and optical coherence tomography revealed resolution of the cystic maculopathy. The improvements were maintained for at least 4 weeks. Intravitreal injections of bevacizumab may provide another treatment option for patients with macular edema from vein occlusions.

0 Bookmarks
 · 
250 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Drugs that prevent the binding of VEGF to its trans-membrane cognate receptors have revolutionized the treatment of the most important chorioretinal vascular disorders: exudative age-related macular degeneration, diabetic macular edema, and retinal vein occlusions. Pegaptanib, which binds to VEGF165 and longer isoforms, ranibizumab and bevacizumab, which bind all VEGF-A isoforms, and aflibercept, which binds VEGF-A, VEGF-B, and placental growth factor, all bind VEGF165 with high affinity. The drugs have relatively long half-lives (7 to 10 days) after intravitreal depot injections and clinical durations of action that usually exceed 4 weeks. Plasma VEGF concentrations decrease after intravitreal injections of bevacizumab and aflibercept because their systemic half-lives are extended by their Fc fragments. Extensive in vitro and in vivo testing shows that the drugs prevent VEGF-mediated activation of endothelial cells while exhibiting little evidence of toxicity. Further anti-VEGF drug development is on-going.
    Expert Review of Clinical Pharmacology 02/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background and Objective: To evaluate the response to intravitreal triamcinolone acetonide for macular edema persisting or recurring despite multiple intravitreal bevacizumab (IVB) treatments for central retinal vein occlusion (CRVO). Patients and Methods: Retrospective interventional case series of 21 eyes with CRVO from 21 patients who were diagnosed with persistent or recurrent macular edema secondary to CRVO and treated with 0.1mL (4mg) intravitreal triamcinolone acetonide (IVTA) after initial treatment with 3 or more IVB injections. Anatomic and visual responses were the study primary outcomes. Results: Mean logarithm of the minimum angle of resolution visual acuity was 1.19 (20/316) immediately before IVTA injection, and improved to 1.04 (20/219) 1 month after IVTA administration (P=0.003). The mean central macular thickness on optical coherence tomography decreased from 533.4 μm immediately before IVTA to 327.9 μm after IVTA injection (P<0.001). No cases of endophthalmitis, retinal detachment, or neovascularization were noted. Conclusions: Intravitreal triamcinolone acetonide appears to improve vision and reduce persistent or recurrent macular edema secondary to CRVO despite multiple bevacizumab injections.
    Journal of ocular pharmacology and therapeutics: the official journal of the Association for Ocular Pharmacology and Therapeutics 05/2014; · 1.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aflibercept is a recently US FDA-approved anti-VEGF agent designed for intravitreal injection. Anti-VEGF agents have recently been demonstrated to be potent inhibitors of neovascular growth and vascular permeability in large clinical trials. The majority of studies of anti-VEGF agents are in the setting of age-related macular degeneration, but studies looking at diabetic macular edema and macular edema from central retinal vein occlusion (CRVO) and branch retinal vein occlusion are increasing the scope of utility of anti-VEGF drugs. Aflibercept for single-use intravitreal injection has been approved in the setting of age-related macular degeneration and in macular edema caused by CRVO in the USA (approval has been sought in Europe). The purpose of this review is to examine the use of aflibercept in the setting of CRVO and the role it may potentially play in the expanding indications for anti-VEGF agents.
    Expert Review of Ophthalmology 01/2014; 8(3).