Early avastin management in acute retinal vein occlusion

ABSTRACT

To evaluate the safety, functional and anatomical effects of intravitreal Avastin [bevacizumab] in treatment of recent retinal venous occlusion. Prospective interventional series non-comparative study. Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt. The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3 months 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 1.25 mg [0.05 ml] of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25 mg/ml as a primary treatment. The mean number of injections was 2.7 [range, 1-6 injections] 6-8 weeks intervals and follow-up for 12 months [range, 913 months]. 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. The mean age of all patients was 65.3 years +/- 8.5 [range, 55-82 years], 20 males and 10 females patients. The mean baseline VA was 20/240 [log MAR 1.08 +/- 0.52] and improved to 20/60 [log MAR 0.48 +/- 0.32] with statistically significance difference change [P<0.001]. The mean baseline CRT was 455 micro m +/- 126 [range, 386510], decreased to 356 micro m +/- 118 [range, 296-416] after 1 month with statistically significance difference change [P<0.02] and to 402 micro m +/- 170 [range, 338-468] after 6 months [P<0.067] and to 250 micro m +/- 48 [range, 200298] 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 1 month of injection. Neither systemic nor intraocular adverse events were reported. 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