Combined Therapy of Bevacizumab and Grid Photocoagulation for Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To evaluate clinical outcomes of a combined therapy of intravitreal bevacizumab and grid laser photocoagulation for macular edema in branch retinal vein occlusion (BRVO). METHODS: In the present retrospective study, medical records of patients who were treated with intravitreal bevacizumab injection for macular edema due to BRVO were reviewed. The eyes were divided into 2 groups, the combined therapy group of intravitreal bevacizumab and grid laser photocoagulation, and the monotherapy group of intravitreal bevacizumab. Visual acuity and central subfield macular thickness were investigated at 1, 2 and 6 months. Recurrence rate was compared between the 2 groups. RESULTS: Among 49 eyes, 18 eyes underwent macular grid photocoagulation and 31 eyes did not receive laser treatment. Laser photocoagulation was performed at 1.2 months after injection on average. Visual acuity improved significantly at 2 and 6 months in the combined therapy group, and at 1, 2 and 6 months in the monotherapy group. Macular thickness decreased significantly compared to baseline at all visits in both groups. There was no significant difference in visual acuity and foveal thickness between the 2 groups. Recurrence at 6 months was significantly less frequent in the combined therapy group (3 eyes, 17%) then in the monotherapy group (14 eyes, 45%, p = 0.046). CONCLUSIONS: Combined grid photocoagulation after intravitreal bevacizumab injection lowered the recurrence rate of macular edema complicated with BRVO.

Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for Exudative Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the efficacies of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab in choroidal neovascularization secondary to age-related macular degeneration and polypoidal choroidal vasculopathy (PCV). METHODS: Photodynamic therapy followed by 3 monthly intravitreal injections of bevacizumab were performed for neovascular age-related macular degeneration (AMD group) and PCV (PCV group). The injections were performed within 2 weeks after PDT and then every 4 to 6 weeks. During the 12-month follow-up period, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and number of reinjections were reviewed retrospectively. RESULTS: Out of 38 eyes, there were 21 eyes in the AMD group (mean age 66.8 years old) and 17 eyes in the PCV group (mean age 66.4 years old). The average follow-up duration was 17.0 months. At 12 months, the BCVA (logMAR) improved from 0.75 at baseline to 0.49 in the AMD group (p = 0.01) and from 0.81 to 0.63 in the PCV group (p = 0.03). The CSMT decreased significantly from 329 to 231 in the AMD group and from 354 to 223 in the PCV group. At 12 months, 20 eyes (95.2%) in the AMD group and 15 eyes (88.2%) in the PCV group increased or maintained BCVA. The numbers of reinjections were 4.3 in the AMD group and 3.0 in the PCV group. There were no significant differences in BCVA, BCVA changes, CSMT, or number of reinjection between the two groups. CONCLUSIONS: Combined PDT and intravitreal bevacizumab injections showed no significant difference in stabilization of vision or retreatment rates between neovascular age-related macular degeneration and PCV.

Intravitreal Bevacizumab With or Without Photodynamic Therapy for the Treatment of Polypoidal Choroidal Vasculopathy

PURPOSE: To compare the efficacy of photodynamic therapy (PDT) using verteporfin combined with intravitreal bevacizumab and bevacizumab monotherapy in polypoidal choroidal vasculopathy (PCV). METHODS: Twenty-six eyes, diagnosed with PCV were reviewed retrospectively. They were divided into two groups: combined treatment (COMB) and bevacizumab monotherapy (BEV). Visual acuity, fluorescein angiography (FA) and indocyanine green angiography (ICG) results were reviewed to compare changes in the polypoidal vessels and the branching vascular networks. RESULTS: Among 26 eyes of 26 patients, there were 12 eyes in the COMB group and 14 eyes in the BEV group. Follow-up periods were about 42 weeks and 48 weeks for the respective groups. In the COMB group, visual acuity improved from log MAR 0.92 to 0.56, whereas visual acuity in the BEV group changed only minimally from log MAR 0.98 to 0.97. In the COMB group, the polypoidal vessel resolved in six eyes. In the BEV group, the polypoidal vessel resolved in one eye. In the COMB group, the vascular network resolved in one eye, improved in ten eyes, and did not change in one eye. In the BEV group, the vascular network did not change in any of the 14 eyes. CONCLUSIONS: Combined treatment with PDT and intravitreal bevacizumab resulted in a more prolonged effect, induced the resolution of polypoidal vessels more effectively than did bevacizumab monotherapy, and is expected to reduce recurrence and retreatment.

Short-term Efficacy of Intravitreal Bavacizumab for Polypoidal Choroidal Vasculopathy

PURPOSE: To evaluate the short-term effect of intravitreal bevacizumab (Avastin(R)) in polypoidal choroidal vasculopathy. METHODS: Intravitreal Avastin(R) was injected into 13 eyes of 13 patients with PCV in this retrospective, interventional case study. The follow-up period lasted over 3 months after therapy. Changes in best-corrected visual acuity (BCVA), foveal height determined by optical coherence tomography, and abnormal vasculature in indocyanine green angiography (ICGA) were evaluated. RESULTS: The mean LogMAR BCVA was 0.82 at baseline, 0.78 at 1 month after treatment, and 0.73 at 3 months after treatment. Visual acuity was stabilized or improved in 13 eyes (100%). The mean foveal height was 288 micrometer at baseline, 231 micrometer (p<0.05) at 1 month after treatment, and 196 micrometer at 3 months after treatment. The polypoidal lesions in ICGA decreased in 4 eyes (31%), although branching vasculature in ICGA was unchanged in 13 eyes (100%). CONCLUSIONS: Intravitreal injection of Avastin(R) may stabilize visual acuity and reduce macular edema due to decreased retinal pigment epithelial detachment and leaking. However, intravitreal injection had a minimal effect in occlusion of the symptomatic polypoidal lesions and no effect in occlusion of the branching vascular network.

A Case of Retinal Contusion Combined Exudative Retinal Detachment Causing Delayed Visual Disturbance

PURPOSE: To report a case of retinal contusion with the complication of exudative retinal detachment causing delayed visual disturbance. CASE SUMMARY: A 28-year-old man presented with visual disturbance of the left eye. Three days prior, a soccer ball hit him on his left eye, and he visited a local clinic. His visual acuity was 0.9. Fundus examination revealed a lesion of the macula, which was diagnosedas retinal contusion. Two days later, visual acuity decreased to 0.3 and he was referred to us. At presentation, his visual acuity was 0.125. A gray to white lesion around the superotemporal vascular arcade, and exudative retinal detachment involving the fovea associated with the lesion were found. Subretinal fluid collection was confirmed with optical coherence tomography (OCT). Fluorescein angiography showed diffuse leakage over the contusion, and fluorescein was pooled in the detached area. At 15 days, subretinal fluid was resolved on OCT and vision was improved to 0.8. CONCLUSIONS: We suggest that leakage from the contusion caused delayed exudative retinal detachment and decrease of visual acuity. Visual acuity improved with resolution of the subretinal fluid. Though the visual acuity was good in spite of a severe retinal contusion on the perifoveal area, the possibility of exudative retinal detachment and delayed visual disturbance shoud be considered.