Role of Avastin in management of central serous chorioretinopathy

Abstract 

Purpose

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC).

Design

Prospective interventional series non-comparative study.

Setting

Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt.

Methods

The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25mg (0.05mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1–3 injections) 6–8weeks intervals and follow up for 6months (range 5–7months). All finding at baseline and each follow up visit were reported and compared.

Results

The mean age of all patients was 40.3years±6.5 (range 25–50years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change (P<0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change (P<0.002). The mean baseline CRT for all patients was 486±86μm (range, 386–580), decreased to 316±56μm (range, 276–368) after 1months with statistically significance difference change (P<0.02) and to 272±52μm (range 220–338) at last follow up with statistically significance difference change from the baseline (P<0.001).

Conclusions

Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.

Keywords: Central serous chorioretinopathy, Avastin (bevacizumab), FA, OCT, Intravitreal injection