Associated Treatment With Intravitreal Bevacizumab And Macular Photocoagulation For Macular Edema Secondary To Central Retinal Vein Occlusion (CRVO)

摘要

Purpose: : The primary objective is to evaluate the safety of the intravitreal bevacizumabe (IVB) associated to macular photocoagulation in the treatment of macular edema secondary to CRVO. The secondary objective is to evaluate the number of injections needed. Methods: : phase I, non-comparative, consecutive, single-arm study of patients with macular edema secondary to CRVO. All patients were submitted to a complete ophthalmological examination, including best-corrected ETDRS visual acuity (BCVA), slit-lamp biomicroscopy, intraocular pressure (IOP) and fundus examination. Fluorescein angiography (FA) and OCT central macular thickness (CMT) measurements were also performed. Patients were seen at baseline, one and seven days after the injections, and every 4 weeks thereafter. FA and OCT were performed at baseline, D30, D60, D90, D120, D150 and D180. A minimum of three consecutive injection four weeks apart up to a maximum of six injections were given until OCT CMT reaches 250 ?μm or less. Laser photocoagulation was performed 4 weeks after CMT goal. Main inclusion criteria: eyes with macular edema; BCVA a?¤ 20/40 and a?￥ 20/800 in the study eye and a?￥ 20/40 in the fellow eye; age a?￥ 50 years old and OCT a?￥ 250 ?μm. Main exclusion criteria: intraocular pressure a?￥ 24 mmHg, iris, angle or fundus neovascularization; CRVO 12 months, use of any intravitreous drug in the past 3 months. Results: : eight eyes of eight patients (3 women and 5 men) were enrolled. Baseline results: mean BCVA was 0.81 logMar (range, 0.4 - 1.0) and CMT was 499 ?μm (range, 278 - 885 ?μm). Mean age was 63.75 years-old (range, 50-82). Seven were Caucasians and 1 was black. Mean number of injections was 3.6 (range, 3-6). At baseline FA showed a non isquemic type in 6 patients and in 2 patients the ischemic form. Last follow-up results: mean BCVA was 0.6 logMar (range, 0.4 - 0.8) and CMT was 210 ?μm (range, 139 -250 ?μm). IOP was within the normal limits throughout the follow-up period. FA didna??t show development of retinal ischemia. After the laser treatment no patient needed a new injection. Neither ocular nor systemic adverse effects were recorded during the study period. Conclusions: : the use of intravitreal bevacizumab associated with macular photocoagulation showed no ocular or systemic adverse effects. VA has improved and CMT measured by OCT has decreased and combined treatment may decrease the need for additional injections. Clinical Trial: : www.irtc.ir, IRTC201011295270N1.