Session Title: Quick Fire Free Paper 5
Session Date/Time: Sunday 14/09/2014 | 11:00-13:00
Paper Time: 11:45
Venue: Boulevard B
First Author: : K.Darrad UK
Co Author(s): : H. Malick P. Stavrou B. Mushtaq S. Elsherbiny A. Mitra P.L. Lip
Bevacizumab is an unlicenced anti-vascular endothelial growth factor (anti-VEGF) agent approved by our local hospital’s Drug and Therapeutic committee and commissioners to treat complications caused by central retinal vein occlusions (CRVOs). We evaluate the macular changes and visual outcomes in patients with macular oedema caused by CRVO following a course of intravitreal Bevacizumab injections at 4 months and at one year; and to establish the safety and adverse effects related to Bevacizumab injections in this group of patients.
Procedure was performed as aseptic technique at out-patient setting, in a tertiary referral teaching hospital. Intravitreal Bevacizumab was given as the first line treatment to new cases of CRVO macular oedema; or as an additional treatment to refractory cases previously failed to respond to laser or intravitreal steroid treatment alone.
Retrospective analysis of consecutive CRVO patients who were registered to have received Bevacizumab treatment for macular oedema from 2009 November to 201May. Patients received a loading dose of intravitreal Bevacizumab (1.25mg/0.05ml) followed by PRN regime where indicated. Loading dose varied from 1 to 3 injections depending on consultants’ discretion. Outcome measures were Logmar vision (Va) and central retinal thickness (CRT) measured with Topcon Ocular Coherence Tomography at pre-injections, at 4-weeks post-loading phase and one year follow-up. Slit-lamp examinations with intraocular pressure measurement and any adverse effects were recorded at each clinic visit. Additional focal laser was applicable at consultants’ discretion based on macular ischaemic status.
We studied 56 patients [26 male; mean age 69(SD12.2); range 34-87). Average number of injections in one year was 4.2 (mode 3, range 1 to 9): 62% were chronic CRVO and received other treatments pre-Bevacizumab, and another 32% required other additional laser treatments post-Bevacizumab. Baseline median CRT was 449μm[IQR 388-553], which was reduced to 287μm[237-402] (paired Wilcoxon, p<0.001) at post-loading and, to 278μm[229-495](p<0.001) at 1 year. Baseline Va was 0.78[IOR 0.48-1.22], which significantly improved to 0.69[0.18-1.0] (paired Wilcoxon, p=0.03]. ‘Stable/improved’ Va at post-loading and one year was 83% and 64%, respectively. Va improved by 3 lines in 22% and 30%, respectively. Adverse effects occurred in 3.5% (one ocular hypertension, one rubeotic glaucoma). Existing risk factors were glaucoma in 37%(21/56) and cardiovascular diseases in 45%(25/56).
Anti-VEGF agents have theoretical benefit of dual actions of reversing the ischaemia and vascular leakage, which are the main causes of complications in a retinovascular event. Our study shows that intravitreal Bevacizumab treatment can lead to significant improvement in macular oedema and visual gains in CRVO patients. The treatment results are maintained at one year although combination therapy and more frequent injections may be required to maintain its effect for longer term in more severe cases, and to prevent complications such as rubeotic glaucoma. There was a low adverse event rate with intravitreal Bevacizumab use.