Intravitreal bevacizumab promising for ischemic CRVO

Las Vegas-Intravitreal bevacizumab (Avastin, Genentech) shows promise as a treatment for macular edema associated with ischemic central retinal vein occlusion (CRVO), said Gregory F. Kozielec, MD, at the annual meeting of the American Academy of Ophthalmology.

"Currently, treatment for ischemic CRVO includes panretinal photocoagulation and proper medical management, but ocular morbidity remains high, with 60% of eyes developing neovascularization of the iris and 33% developing neovascular glaucoma," Dr. Kozielec said. "The results achieved with intravitreal bevacizumab are encouraging but preliminary. The short-term findings from this nonrandomized, uncontrolled, retrospective study preclude estimation of the treatment's safety or long-term efficacy. However, they suggest further investigation is warranted."

The 35 patients in the retrospective review represented a consecutive series treated between June 2005 and July 2006. No patient had received any prior intravitreal injections or laser treatment. A medical history of hypertension was present in 31 (89%) patients, and 15 (43%) had diabetes.

The bevacizumab injection was administered in sterile fashion, and patients received topical antibiotic treatment for 1 week postinjection. Follow-up exams were performed at 1 week, 1 month, and monthly thereafter, and all patients were seen at 6 months. All patients had fluorescein angiography performed at the initial examination. Ischemic CRVO was diagnosed in all 35 eyes as defined by the presence of greater than 10 disc areas of retinal capillary nonperfusion. Gonioscopy was performed monthly, and OCT was used to measure foveal thickness.

A repeat injection was given at 1 month at the discretion of the treating physician, based on assessment of the OCT results for the macular edema. The 35 patients received a total of 55 injections.

During the follow-up period, no patient underwent panretinal photocoagulation. All patients were encouraged to visit their internist for proper medical management.