Avastin & retinal vein occlusion (research)
- VEGF = vascular endothelial growth factor
- IVA = Intravitreal Avastin
- ARMD = age-related macular degeneration
- IVT in United States may be an abbreviation for intravitreal
treatment, not intravitreal triamcinolone as on this
Avastin & retinal vein occlusion (research)
Epstein DL, Algvere PV, von Wendt G, Seregard S, Kvanta A.
Benefit from Bevacizumab for Macular Edema in Central Retinal Vein Occlusion: Twelve-Month Results of a Prospective, Randomized Study.
Ophthalmology. 2012 Aug 16. [Epub ahead of print]
Singer, Michael A. MD; Bell, Darren J. MD; Woods, Paul BS; Pollard, Joseph MPH; Boord, Terry PhD; Herro, Angela MD; Porbandarwalla, Salman MD
Effect of Combination Therapy With Bevacizumab and Dexamethasone Intravitreal Implant in Patients With Retinal Vein Occlusion
Retina: July 2012 - Volume 32 - Issue 7 - p 1289–1294 doi: 10.1097/IAE.0b013e318242b838
"the combination of a vascular endothelial growth factor inhibitor and a dexamethasone implant may be a valuable option for RVO treatment."
DeCroos FC, Ehlers JP, Stinnett S, Fekrat S.
Intravitreal bevacizumab for macular edema due to central retinal vein occlusion: perfused vs. ischemic and early vs. late treatment.
Curr Eye Res. 2011 Dec;36(12):1164-70. Epub 2011 Oct 6.
CONCLUSIONS: IVB improves foveal thickness in eyes with CRVO, but this does not always correlate with visual recovery. No difference in efficacy was observed for IVB treatment of perfused versus ischemic CRVO or when used for early versus late treatment.
Ehlers JP, Decroos FC, Fekrat S.
Intravitreal bevacizumab for macular edema secondary to branch retinal vein occlusion.
Retina. 2011 Oct;31(9):1856-62.
CONCLUSION: Intravitreal bevacizumab appears to be an effective treatment for macular edema secondary to branch retinal vein occlusion in many subjects. Eyes treated with intravitreal bevacizumab showed a significant reduction in central foveal thickness and improvement in visual acuity. Early treatment with intravitreal bevacizumab resulted in a greater improvement in visual acuity compared with delayed treatment.
L, Arevalo JF, Roca JA, Maia M, Berrocal MH, Rodriguez FJ, Evans T,
Costa RA, Cardillo J; FOR THE PAN-AMERICAN COLLABORATIVE RETINA STUDY
COMPARISON OF TWO DOSES OF INTRAVITREAL BEVACIZUMAB (AVASTIN) FOR TREATMENT
OF MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION: Results From
the Pan-American Collaborative Retina Study Group at 6 Months of Follow-Up.
Retina. 2008 Feb;28(2):212-219.
CONCLUSION:: There were no statistically
significant differences between the two dose groups with regard to the
number of injections and anatomical and functional outcomes. Intravitreal
injection of bevacizumab at doses up to 2.5 mg appears to be effective
in improving BCVA and reducing CMT in BRVO in the short term. Multiple
injections are needed in a large number of eyes for continued control
of macular edema and preservation of visual acuity in the short term.
Longer studies are needed to determine what role if any intravitreal
injection of bevacizumab may play in the long-term treatment of this
condition. DK: 45 eyes
K, Michels S, Prager F, Georgopoulos M, Funk M, Geitzenauer W, Schmidt-Erfurth
Intravitreal avastin for macular edmema secondary to retinal vein occlusion
- a prospective study.
Br J Ophthalmol. 2008 Jan 22; [Epub ahead of print]
CONCLUSION: Intravitreal injections of bevacizumab
appear to be a safe and effective therapy in the treatment of macular
edema secondary to retinal vein occlusion.
DK: No comment on VA 29 eyes
TC, Alge CS, Wolf AH, Kook D, Burger J, Strauss R, Kunze C, Haritoglou
C, Kampik A, Priglinger S.
Intravitreal bevacizumab for the treatment of macular oedema secondary
to branch retinal vein occlusion.
Br J Ophthalmol. 2008 Mar;92(3):351-5. Epub 2008 Jan 22.
CONCLUSION: Intravitreal injection of 1.25
mg bevacizumb appears to be an effective treatment option for branch
retinal vein occlusion.
DK: 34 patients, no control group, vision improved
MM, Moschos M.
Intraocular bevacizumab for macular edema due to CRVO. A multifocal-ERG
and OCT study.
Doc Ophthalmol. 2008 Mar;116(2):147-52. Epub 2008 Jan 10.
Conclusion The intravitreal use of bevacizumab
may provide anatomical and functional amelioration of the macula in patients
with macular edema due to CRVO. However, further study is needed in order
to assess the treatment's long-term efficacy.
DK: 10 eyes, reduced thickness
J, Kaiser RS, Sivalingam A, Abraham P, Fineman MS, Samuel MA, Vander
JF, Regillo CD, Ho AC.
Intravitreal bevacizumab (avastin) in central retinal vein occlusion.
Retina. 2007 Oct;27(8):1013-9.
CONCLUSIONS: The visual benefits of intravitreal
bevacizumab for macular edema due to CRVO are apparent early but are
not sustained without repeated injections. Larger clinical studies with
long-term follow-up will be necessary to better elicit the best regimen
for this therapy.
DK: 30 eyes, better vision for 2 months
SG, Wolf AH, Kreutzer TC, Kook D, Hofer A, Strauss RW, Alge CS, Kunze
C, Haritoglou C, Kampik A.
Intravitreal bevacizumab injections for treatment of central retinal vein
occlusion: six-month results of a prospective trial.
Retina. 2007 Oct;27(8):1004-12.
CONCLUSION: Intravitreal injection of bevacizumab
appears to be a new treatment option for patients with macular edema
secondary to CRVO.
46 eyes, no control, improved VA
DC, Koizumi H, Spaide RF.
Early bevacizumab treatment of central retinal vein occlusion.
Am J Ophthalmol. 2007 Dec;144(6):864-71. Epub 2007 Oct 4.
CONCLUSIONS: The patients experienced a dramatic
improvement in the visual acuity and clinical fundus appearance, without
collateral vessel formation. These findings are difficult to explain
with current theories of the pathophysiologic features of CRVO. These
findings also suggest early initiation of anti-vascular endothelial growth
factor (VEGF) treatment should be studied in a larger trial for CRVO.
DK: 6 eyes, all gained vision, early injections, 4-10 injections
SH, Kwon YA, Oh HS, Kim M, Kwon OW.
Short-term results of intravitreal bevacizumab for macular edema with retinal
vein obstruction and diabetic macular edema.
J Ocul Pharmacol Ther. 2007 Aug;23(4):387-94.
CONCLUSIONS: An intravitreal bevacizumab
injection for ME caused by RVO and DME was safe and effective for improving
visual acuity and reducing CRT.
DK: 40 eyes, improved vision, no control
NS, Bakri SJ.
Intravitreal triamcinolone and bevacizumab combination therapy for macular
edema due to central retinal vein occlusion refractory to either treatment
Eye. 2007 Aug;21(8):1128-30. Epub 2007 Jun 22. No abstract available.
Y, Freund KB, Peiretti E, Cooney MJ, Ferrara DC, Yannuzzi LA.
Rebound macular edema following bevacizumab (Avastin) therapy for retinal
venous occlusive disease.
Retina. 2007 Apr-May;27(4):426-31.
CONCLUSION: These cases suggest a potential
limitation of using relatively short-acting VEGF antagonists in retinal
vascular disease of a chronic nature. Frequent repeated injections may
be required to prevent a rebound effect with no clearly defined endpoint.
Until the long-term safety of multiple injections of these agents is
established, the authors recommend caution in using this treatment strategy.
DK: 3 patients, rebound
MD, Pieramici DJ, Castellarin AA, Nasir MA, Avery RL.
Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary
to branch retinal vein occlusion.
Retina. 2007 Apr-May;27(4):419-25.
CONCLUSION: The observed anatomic (by ophthalmic
examination, OCT, and/or fluorescence angiography) and visual acuity
improvements and lack of serious adverse side effects after intravitreal
bevacizumab injection demonstrates, in principle, the potential of bevacizumab
for the treatment of ME in this setting.
DK: 27 patients, 1 line of vision, (repeated injections), 200μ reduced
thickness from 500>300
AE, Schaal KB, Dithmar S.
[Central and branch retinal vein occlusion. Current strategies for treatment
in Germany, Austria and Switzerland]
Ophthalmologe. 2007 Apr;104(4):290-4. German.
A, Agostini H, Hansen LL, Feltgen N.
Bevacizumab in retinal vein occlusion-results of a prospective case series.
Graefes Arch Clin Exp Ophthalmol. 2007 Oct;245(10):1429-36. Epub 2007 Mar
PMID: 17356824 [PubMed - indexed
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
DK: 40 patients, must give early, no long term follow up
Intravitreal triamcinolone acetonide vs bevacizumab for
treatment of macular oedema due to central retinal vein occlusion.
Feb 13. [Epub ahead of print]
Triamcinolone no benefit versus Avastin
and more adverse events, 43 patientsSchaal
KB, Höh AE, Scheuerle A, Schütt F, Dithmar S.
[Bevacizumab for the treatment of macular edema secondary to retinal vein occlusion]
Ophthalmologe. 2007 Apr;104(4):285-9. German. DK:20 patients safe
J Hou, Y-R Jiang, X-X Liand J B Jonas
Intravitreal bevacizumab vs triamcinolone acetonide for macular
oedema due to central retinal vein occlusion
Eye (2010) 24, 810–815; doi:10.1038/eye 2009.220;For central rvo, comparing IVT to IVA
(triamcinolone to Avastin) IVT reduces oedema more but causes more side
Comparison of two doses of intravitreal
bevacizumab as primary treatment for macular edema secondary to central
retinal vein occlusion: results of the pan American collaborative retina
study group at 24 months. Retina. 2010
no difference 1.25/2.5mg dose
Rouvas, Alexander MD, PhD; Petrou,
Petros MD; Ntouraki, Amalia MD; Douvali, Maria MD; Ladas, Ioannis MD, PhD;
Vergados, Ioannis MD, PhD
INTRAVITREAL RANIBIZUMAB (LUCENTIS) FOR BRANCH RETINAL VEIN OCCLUSION-INDUCED
June 2010 - Volume 30 - Issue 6 - pp 893-902Nine-Month Results of a Prospective
Study "Individualized repeated intravitreal injections of ranibizumab
showed promising short-term results in visual acuity improvement and decrease
in CFT in patients with macular edema associated with branch retinal vein
occlusion. Further studies are needed to prove the long-term effect of
ranibizumab treatment on patients with branch retinal vein occlusion"
M S Figueroa, I Contreras, S Noval,
Results of bevacizumab as the primary treatment for retinal vein occlusions
J Ophthalmol 2010;94 1052-1056Very helpful, but repeated injections
N J Shah1 and
U N Shah1
Long-term effect of early intervention with single intravitreal injection of
bevacizumab followed by panretinal and macular grid photocoagulation in central
retinal vein occlusion (CRVO) with macular edema: A pilot study
(2011) 25, 239–244;doi:10.1038 /eye.2010.225"Early intravitreal bevacizumab
followed by panretinal and macular grid laser may provide visually and
anatomically favourable results in a case of CRVO. It may also obviate
the need for repeated injection. It requires a large randomized study to
substantiate the results."
Treatment of macular edema due to retinal vein occlusions.
Ophthalmol. 2011;5:705-13. Epub 2011 May 24.
Retinal vein occlusion (RVO) is a prevalent retinal vascular disease,
second only to diabetic retinopathy. Previously there was no treatment
for central retinal vein occlusion (CRVO) and patients were simply observed
for the development of severe complications, generally resulting in poor
visual outcomes. The only treatment for branch vein occlusion (BRVO)
was grid laser photocoagulation, which reduces edema very slowly and
provides benefit in some, but not all patients. Within the past year,
clinical trials have demonstrated the effects of three new pharmacologic
treatments, ranibizumab, triamcinolone acetonide, and dexamethasone implants.
The benefit/risk ratio is best for intraocular injections of ranibizumab,
making this first-line therapy for most patients with CRVO or BRVO, while
intraocular steroids are likely to play adjunctive roles. Standard care
for patients with RVO has changed and will continue to evolve as results
with other new agents are revealed.