Visual improvement in central retinal vein occlusion (CRVO) following intravitreal injections of bevacizumab (Avastin(®) )

Hyperacute iris neovascularization following cataract surgery

RATIONALE

We describe a case of acute neovascularization of the iris after uneventful cataract surgery.

PATIENT CONCERNS

A 78-year-old man visited our clinic for cataract surgery and glaucoma management.

DIAGNOSES

The patient underwent bilateral laser iridotomy 4 years ago. On ocular examination, the best-corrected visual acuity was no light perception in the right eye and 20/100 in the left eye. We observed pseudophakic bullous keratopathy in the right eye and cataracts and hemicentral retinal vein occlusion (CRVO) in the left eye.

INTERVENTIONS

The patient underwent cataract surgery in the left eye without complications.

OUTCOMES

The day after surgery we observed 360° of neovascularization in the iris and aggravated hemi-CRVO with macular edema. Therefore, we administered intravitreal bevacizumab in the left eye, after which the iris neovascularization and macular edema improved.

LESSONS

Cataract surgery can rapidly aggravate hemi-CRVO and cause iris neovascularization, which is responsive to bevacizumab.

SCORE2 Report 2: Study Design and Baseline Characteristics

PURPOSE

To describe the design and baseline characteristics of participants in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2) and to compare with cohorts from other retinal vein occlusion trials.

DESIGN

Phase III prospective, multicenter, randomized clinical trial designed to assess whether intravitreal bevacizumab is noninferior to intravitreal aflibercept for treatment of decreased vision attributable to macular edema associated with central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO).

PARTICIPANTS

Total of 362 participants: 307 with CRVO and 55 with HRVO.

METHODS

Demographic and study eye characteristics are summarized and compared between CRVO and HRVO study participants.

MAIN OUTCOME MEASURES

Baseline ophthalmic characteristics, including visual acuity and retinal thickness, and medical history characteristics, including hypertension, diabetes mellitus, and coronary artery disease.

RESULTS

The mean age of participants was 69 years, 76% of participants were white, and 90% were non-Hispanic. There was a racial disparity with respect to disease type, with 38% of HRVO patients being black compared with 11% of CRVO patients (P value adjusted for multiple testing = 0.0001). This is similar to findings from the previous SCORE Study. Comorbidities included hypertension (77%), diabetes mellitus (31%), and coronary artery disease (15%). At baseline, mean visual acuity letter score was 50 (20/100) (range, 19-73 [20/400 to 20/40]), mean optical coherence tomography (OCT)-measured central subfield thickness was 678 μm (range, 300-1203 μm), and mean number of months from diagnosis of macular edema to randomization was 6 (range, 0-104 months). One hundred twenty (33%) SCORE2 participants had been treated previously with anti-vascular endothelial growth factor (anti-VEGF) therapy, with these participants having baseline visual acuity letter score and OCT-measured central subfield thickness similar to those without prior anti-VEGF treatment, but longer mean duration of macular edema before randomization (18 months vs. 1 month for those without prior anti-VEGF treatment; P < 0.0001).

CONCLUSIONS

The SCORE2 cohort is a heterogeneous population, including both CRVO and HRVO eyes and both treatment-naïve eyes and eyes treated previously with anti-VEGF, which will allow study results to have broad applicability to CRVO and HRVO patients receiving treatment for macular edema. Similarities of the baseline characteristics of the SCORE2 population to other CRVO trial cohorts will allow meaningful comparisons of outcome results across trials.

Outcomes of Patients Initially Treated with Intravitreal Bevacizumab for Central Retinal Vein Occlusion: Long-Term Follow-Up

BACKGROUND AND OBJECTIVE

To assess outcomes of visual acuity (VA) and central retinal thickness (RT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) who were initially treated with bevacizumab and followed for up to four years.

STUDY DESIGN/MATERIALS AND METHODS

In this observational case series, 51 patients with non-ischemic and ischemic CRVO who had initial treatment with bevacizumab were included. Main outcome measures were VA and RT at one year, with follow-up of up to four years.

RESULTS

Mean VA improved from 20/214 at baseline to 20/107 at one year (p = 0.0009) and this improvement was maintained clinically at four years. RT decreased from 595 μm to 339 μm at one year (p = 0.0027) and this was maintained at four years.

CONCLUSION

Patients who received bevacizumab as initial therapy for ME from CRVO maintained VA and RT improvement for up to four years.

Bevacizumab treatment reduces retinal neovascularization in a mouse model of retinopathy of prematurity

AIM

To evaluate the effect of different bevacizumab concentrations on retinal neovascularization in a retinopathy of prematurity (ROP) mouse model.

METHODS

A total of 60 of C57BL/6 J mice were exposed to 75%±2% oxygen from postnatal d7 to postnatal d12. Fifteen nonexposed mice served as negative controls (group A). On d12, 30 mice (group C) were injected with 2.5 µg intravitreal bevacizumab (IVB), 30 mice (group D) were injected with 1.25 µg IVB in one eye. The contralateral eyes were injected with balanced salt solution (BSS) (control group=group B). The adenosine diphosphatase (ADPase) histochemical technique was used for retinal flat mount to assess the oxygen-induced changes of retinal vessels. Neovascularization was quantified by counting the endothelial cell proliferation on the vitreal side of the inner limiting membrane of the retina. Histological changes were examined by light microscopy. The mRNA levels of vascular endothelial growth factor (VEGF) were quantified by Real-time PCR. Western-blotting analysis was performed to examine the expression of P-VEGFR.

RESULTS

Comparing with the control group B, regular distributions and reduced tortuosity of vessels were observed in our retinal flat mounts in groups C and D. The endothelial cell count per histological section was lower in groups C (P<0.0001) and D (P<0.0001) compared with the control group B. Histological evaluation showed no retinal toxicity in any group. In all oxygen treated groups VEGF mRNA expression was significantly increased as compared to age-matched controls. No significant change in VEGF mRNA expression could be achieved in either of the treatments or the oxygen controls. The results of the Western blot were consistent with that of the Real-time PCR analysis.

CONCLUSION

An intravitreal injection of Bevacizumab is able to reduce angioproliferative retinopathy in a mouse model for oxygen-induced retinopathy.

Intravitreal Bevacizumab in Central Retinal Vein Occlusion: 18-month Results of a Prospective Clinical Trial

Purpose.

To evaluate the long-term visual results in central retinal vein occlusion (CRVO) following repeated intravitreal injections of bevacizumab (IVB).

Methods.

Thirteen patients (aged 34 to 79 years) with a duration of CRVO of 2 weeks to 6 months (mean 2.5 months) had a best-corrected visual acuity (BCVA) 0.05 to 0.4 (mean 0.13) as determined by Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Clinical examination was carried out at baseline and every 6 to 8 weeks. Intravitreal bevacizumab (1.25 mg) was given every 6 weeks during the first 6 months, and after that at the discretion of the attending physician.

Results.

In total, 96 IVB (average 7.4/patient) were given: 50 IVB during the first 6 months, 28 from 6 to 12 months, and 18 from 12 to 18 months. Average BCVA had improved 15 ETDRS letters at 3 months, 24 letters at 6 months, 24 letters at 12 months, and 18 letters at 18 months (p<0.05). Eight patients (62%) had gained >15 ETDRS letters at 12 months, and 7 subjects (54%) >15 ETDRS letters at 18 months. Foveal thickness decreased from 596 μm at baseline to 294 μm at 18 months (p<0.05) and mean IOP from 15.2 mmHg to 15.8 mmHg. No serious adverse events occurred.

Conclusions.

Following repeated IVB, there was a significant gain of BCVA during the follow-up of 18 months. To maintain visual gain, regular ophthalmologic examinations and repeated injections seem to be necessary as long as the disease is active.

Intravitreal bevacizumab combined with grid photocoagulation in recurrent macular edema secondary to retinal vein occlusion

PURPOSE

To evaluate improvement in best-corrected visual acuity (BCVA) and the reduction of central retinal thickness (CRT) in patients with macular edema secondary to retinal vein occlusion (RVO) after intravitreal bevacizumab (IVB) injection combined with macular grid photocoagulation.

METHODS

A retrospective study of 54 consecutive eyes with macular edema associated with RVO. The BCVA and CRT, recorded with spectral-domain optical coherence tomography, were evaluated at baseline and 1, 3, 6, and 12 months after treatment onset. Intravitreal bevacizumab injection was administered at baseline, and macular grid photocoagulation 15 days later. During follow-up, additional IVB, at 1-month intervals, was administered if persistent or recurrent macular edema was observed on optical coherence tomography.

RESULTS

Best-corrected visual acuity was improved and CRT was reduced at 1, 3, 6, and 12 months of follow-up. Compared with initial values, the final CRT was significantly reduced in patients with branch RVO (35 patients) and in patients with central RVO (19 patients) (p<0.05). Also, BCVA was significantly improved in both groups of patients (p<0.05).

CONCLUSIONS

Intravitreal bevacizumab injection combined with macular grid photocoagulation reduces recurrent macular edema associated with branch RVO and central RVO.

Effect of a single intravitreal bevacizumab injection on contrast sensitivity and macular thickness in eyes with macular edema from central retinal vein occlusion: a prospective, nonrandomized, three-month follow-up study

PURPOSE

To evaluate the results of intravitreal bevacizumab (IVB) injection on contrast sensitivity (CS), best-corrected visual acuity (BCVA), foveal thickness (FT) and macular volume (MV) as measured by optical coherence tomography in patients with macular edema (ME) from central retinal vein occlusion (CRVO).

METHODS

Sixteen consecutive eyes from 16 patients with ME from unilateral CRVO were treated with a single IVB injection. The CS, BCVA, FT and MV measurements were obtained before the treatment and 1 and 3 months after the injection.

RESULTS

CS demonstrated significant improvement at all spatial frequencies - 1.5, 3, 6, 12 and 18 cycles per degree (cpd) - 1 month after the injection and at 6 cpd at the 3-month follow-up. The mean BCVA measurements in log of the minimum angle of resolution (logMAR) units improved from 1.03 at baseline to 0.83 logMAR 1 month after the injection, but worsened to 0.97 logMAR at 3 months. The mean baseline FT ± standard deviation (SD; 620.06 ± 177.60 µm) was reduced significantly 1 month (270.93 ± 74.17 µm) and 3 months (535.56 ± 222.33 µm) after the treatment. The mean baseline MV ± SD (12,765.56 ± 3,769.70 mm(3)) was reduced significantly at the 1-month (8,324.93 ± 932.04 mm(3)) and 3-month (11,319.44 ± 3,044.74 mm(3)) follow-up visits.

CONCLUSIONS

IVB improved CS, BCVA, FT and MV within a short time period (1 month). Although VA was not improved at 3 months, improvements were observed for CS, FT and MV, which indicates that, despite ME recurrence, there still was some benefit to visual function.

Early panretinal photocoagulation for ERG-verified ischaemic central retinal vein occlusion

PURPOSE

We have previously shown that photopic cone b-wave implicit time ≥ 35.0 ms in 30 Hz flicker electroretinography (ERG) predicts ocular neovascularization (NV) in central retinal vein occlusion (CRVO). Here, we evaluate the effects of early panretinal photocoagulation (PRP) in patients with ERG-verified ischaemic CRVO.

METHODS

Patients with CRVO, admitted to our department between 2000 and 2008, were classified as having ischaemic or non-ischaemic CRVO based on the ERG-results. In a first group of 71 patients, 18 patients had ischaemic CRVO and were assigned to standard treatment that is regular examinations and PRP as soon as NV was found. In a consecutive group of 65 patients, 18 patients with ischaemic CRVO received early PRP. In this group, ERG was performed on average 6 weeks after the first symptoms of CRVO. The patients underwent PRP as soon as possible after the ERG-examination, and the treatment was completed within one to three sessions.

RESULTS

Twelve patients in the standard treatment group developed neovascular glaucoma during a mean period of 5 months after the CRVO. In the early treatment group, one patient developed subtle iris rubeosis 7 months after PRP. Otherwise, none of the patients showed any signs of ocular NV, and the intraocular pressure remained within normal range, without the necessity of supplementary medication, during a mean follow-up of 41 months.

CONCLUSIONS

This study indicates that ocular NV in patients with CRVO can be predicted by photopic 30 Hz flicker ERG and that early PRP in ERG-verified ischaemic CRVO could be suggested as standard treatment.