Early Avastin management in acute retinal vein occlusion

Abstract 

Purpose

To evaluate the safety, functional and anatomical effects of intravitreal Avastin (bevacizumab) in treatment of recent retinal venous occlusion.

Design

Prospective interventional series non-comparative study.

Setting

Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt.

Methods

The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3months duration 12 eyes (40%) of patients with central retinal vein occlusion (CRVO) and 18 eyes (60%) with branch retinal vein occlusion (BRVO) were injected with intravitreal bevacizumab 1.25mg (0.05ml) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25mg/ml as a primary treatment. The mean number of injections was 2.7 (range, 1–6 injections) 6–8weeks intervals and follow-up for 12months (range, 9–13months). Patients underwent visual acuity testing (VA) as functional assessment. Anatomically, optical coherence tomography (OCT) is used for measurement of central retinal thickness (CRT) to detect macular edema (ME), fundus photography and fluorescein angiography (FA) to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported.

Results

The mean age of all patients was 65.3years±8.5 (range, 55–82years), 20 males and 10 females patients. The mean baseline VA was 20/240 (logMAR 1.08±0.52) and improved to 20/60 (logMAR 0.48±0.32) with statistically significance difference change (P<0.001). The mean baseline CRT was 455μm±126 (range, 386–510), decreased to 356μm±118 (range, 296–416) after 1month with statistically significance difference change (P<0.02) and to 402μm±170 (range, 338–468) after 6months (P<0.067) and to 250μm±48 (range, 200–298) at last follow-up with statistically significance difference change from the baseline (P<0.001). There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1month of injection. Neither systemic nor intraocular adverse events were reported.

Conclusions

Intravitreal Avastin (IVA) is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion.

Keywords: Retinal venous occlusion, Avastin (bevacizumab) CRVO, BRVO, FA and OCT, Intravitreal injection