Intravitreal bevacizumab for vitreous haemorrhage - Wiley Online Library

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Shields CL, Cater J, Shields JA, Singh AD,. Santos MC ... Singh AD, Mokashi AA, Bena JF, Jacques. R, Rundle PA ... Email: [email protected]. Intravitreal ...
Acta Ophthalmologica 2008

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Correspondence: Dr Haraldur Sigurdsson Landspitali - University Hospital Eiriksgata 37 101 Reykjavı´ k Iceland Tel: + 354 543 1000 Fax: + 354 543 4830 Email: [email protected]

Intravitreal bevacizumab for vitreous haemorrhage Jost B. Jonas, Teodosio Libondi, Stefan von Baltz and Urs Vossmerbaeumer Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-KarlsUniversity, Heidelberg, Germany doi: 10.1111/j.1600-0420.2007.01107.x

Editor, itreous haemorrhage is one of the major complications of ischaemic retinopathies such as diabetic retinopathy. If it does not resolve spontaneously, pars plana vitrectomy is usually performed to restore vision and to allow an ophthalmoscopic assessment of the fundus for eventual laser coagulation of the retina. The general rule of therapy is to prefer a minimally invasive procedure, but pars plana vitrectomy, although intensively developed and refined, still

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represents a major intervention. We describe the clinical outcome of patients who underwent a less invasive intervention than pars plana vitrectomy for persistent vitreous haemorrhage. Our clinical interventional case series study included 10 patients (11 eyes) who presented with vitreous haemorrhage resulting from proliferative diabetic retinopathy (10 eyes) or ischaemic retinal vein occlusions (one eye). All haemorrhages had persisted for ‡ 3 months. Mean age was 62.1 ± 14.5 years (median 58.4 years, range 45.8–90.8 years), and mean visual acuity was 1.65 ± 0.97 logMAR (logarithm of the minimal angle of resolution). Mean intraocular pressure was 14.6 ± 3.6 mmHg (range 12–22 mmHg). An iris neovascularization was detected in one (9%) eye, and five (45%) eyes were pseudophakic. All eyes received an intravitreal injection of 1.5 mg bevacizumab. A second intravitreal injection of 1.5 mg bevacizumab was performed in two (17%) eyes at 3 weeks and 3 months, respectively, after the first injection. The second injection at 3 months was administered because the vitreous haemorrhage had partially, but not completely, resolved. All patients were fully informed about the experimental character of the treatment and gave signed, informed consent. At the end of follow-up at 3.9 ± 2.3 months (range 1–6 months) after the first injection, the vitreous haemorrhage had cleared without any further intervention in all but one (9%) eye. Visual acuity improved significantly (p = 0.02) from 1.65 ± 0.97 logMAR to 0.98 ± 0.67 logMAR. Intraocular pressure remained in the normal range (mean 14.6 ± 3.5 mmHg) with no significant (p = 0.94) difference to baseline values. There were no signs of intraocular inflammation or other changes that might be regarded as side-effects of the intravitreal bevacizumab injections. After clearing of the vitreous haemorrhage, four (36%) eyes underwent panretinal laser coagulation to reduce the ischaemic stimulus for neovascularization and secondary haemorrhage. Since the first reports by Rosenfeld et al. (2005), intravitreal bevacizumab has been used on an increasing and worldwide basis for treatment of

exudative and oedematous macular diseases such as exudative age-related macular degeneration, retinal vein occlusions and diffuse diabetic macular oedema. In agreement with recent reports on the regression of intraocular neovascularizations after intravitreal bevacizumab injections (Avery et al. 2006; Mason et al. 2006; Oshima et al. 2006; Spaide & Fisger 2006), the present study may suggest extending the use of intravitreal bevacizumab to persistent vitreous haemorrhages resulting from ischaemic retinopathies in an attempt to speed up the clearing of intravitreal blood and to avoid pars plana vitrectomy. We can assume that the intravitreal bevacizumab reduced the continuous intravitreal leakage and bleeding, thereby shifting the balance towards resolution of the vitreous haemorrhage. We should be aware that the effect of intravitreal bevacizumab may not last forever, and that additional procedures, such as retinal laser coagulation, may become necessary as soon as the vitreous cavity has cleared. There are limitations to the present study. One of the most important concerns the lack of a matched control group, so that although the results of the present study hint that the resolution of the vitreous haemorrhage was brought about by intravitreal bevacizumab, they do not prove that this was so. Further studies may assess whether an intravitreal bevacizumab injection as a preparatory step for an eventual pars plana vitrectomy in eyes with persisting vitreous haemorrhage is clinically helpful.

References Avery RL, Pearlman J, Pieramici DJ et al. (2006): Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 113: 1695. e1–15. Mason JO III, Nixon PA & White MF (2006): Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol 142: 685–688. Oshima Y, Sakagushi H, Gomi F & Tano Y (2006): Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol 142: 155–158. Rosenfeld PJ, Moshfeghi AA & Puliafito CA (2005): Optical coherence tomography

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findings after an intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging 36: 331–335. Spaide RF & Fisger YL (2006): Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous haemorrhage. Retina 26: 275–278.

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Correspondence: Dr Jost B. Jonas Universita¨ts-Augenklinik Theodor-Kutzer-Ufer 1)3 D-68167 Mannheim Germany

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