www.diabeticretinopathy.org.uk

Avastin & retinal vein occlusion (research)

 

David Kinshuck

 

abbreviations

  • 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 website.

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.

Wu L, Arevalo JF, Roca JA, Maia M, Berrocal MH, Rodriguez FJ, Evans T, Costa RA, Cardillo J; FOR THE PAN-AMERICAN COLLABORATIVE RETINA STUDY GROUP (PACORES).
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

Kriechbaum K, Michels S, Prager F, Georgopoulos M, Funk M, Geitzenauer W, Schmidt-Erfurth U.
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

Kreutzer 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 a  little

Moschos 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

Hsu 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

Priglinger 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

Ferrara 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

Byeon 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

Ekdawi NS, Bakri SJ.
Intravitreal triamcinolone and bevacizumab combination therapy for macular edema due to central retinal vein occlusion refractory to either treatment alone.
Eye. 2007 Aug;21(8):1128-30. Epub 2007 Jun 22. No abstract available.

Matsumoto 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

Rabena 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

Höh 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.
Widespread use

Stahl 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 14.
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 reached.
DK: 40 patients, must give early, no long term follow up

 

Wu WC, Cheng KC, Wu HJ. Intravitreal triamcinolone acetonide vs bevacizumab for treatment of macular oedema due to central retinal vein occlusion. Eye. 2009 Feb 13. [Epub ahead of print] Links
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

Y Tao, 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 effects (glaucoma)

Wu L, Arevalo JF, Berrocal MH, Maia M, Roca JA, Morales-Cantón V, Alezzandrini AA, Díaz-Llopis MJ.
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 Jul-Aug;30(7):1002-11. 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 MACULAR EDEMA
Retina: 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, C Arruabarrena
Results of bevacizumab as the primary treatment for retinal vein occlusions
Br J Ophthalmol 2010;94 1052-1056Very helpful, but repeated injections needed

 

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
Eye (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."

Channa R, Smith M, Campochiaro PA
Treatment of macular edema due to retinal vein occlusions.
Clin 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.