LIPEMIA RETINALIS DURING CHEMOTHERAPY WITH ADJUNCTIVE GLUCOCORTICOID TREATMENT IN A PATIENT WITH COLON CARCINOMA.

PURPOSE: The purpose of this report is to describe a case of lipemia retinalis due to decompensating hyperlipidemia that occurred during chemotherapy in a patient with metastatic colon carcinoma. METHODS: Retrospective case report. RESULTS: A 55-year-old non-insulin-dependent diabetic man with well-controlled hyperlipidemia presented himself with temporarily blurred vision in both eyes occurring during chemotherapy. He was found to have lipemia retinalis in his both eyes. Blood tests revealed elevated cholesterol and triglyceride levels exceeding 8,200 mg/dL. He received six cycles of FOLFIRI/bevacizumab and accompanying dexamethasone because of colon cancer with pulmonary metastases. Lipemia retinalis had resolved after a 6-week follow-up when chemotherapy was finished, and the patients' triglyceride and glucose levels decreased to normal values. CONCLUSION: Lipemia retinalis associated with visual impairment may occur during chemotherapy under accompanying treatment with dexamethasone. Even if patients with hyperlipidemia are metabolically well-controlled with oral medication, treatment with dexamethasone can potentially lead to decompensation of hyperlipidemia causing secondary lipemia retinalis.

Anti-vascular endothelial growth factor for unilateral acute idiopathic maculopathy.

PURPOSE: To describe a case of unilateral acute idiopathic maculopathy (UAIM) response to intravitreal therapy with aflibercept (Eylea). METHODS: Retrospective case report. RESULTS: A 36-year-old woman with sudden visual impairment and central scotoma was found to have a UAIM in her left eye. Three weeks after continuous worsening of her visual acuity and central scotoma, the patient was treated with intravitreal injections of aflibercept. The visual acuity increased and the macula lesion regressed, causing macula scarring after 2 injections. CONCLUSIONS: Intravitreal injections of aflibercept could be a therapy option in patients with UAIM without signs of spontaneous resolution of the clinical manifestations and visual improvement.

Capsular bag-fixated and ciliary sulcus-fixated intraocular lens centration after supplementary intraocular lens implantation in the same eye.

PURPOSE: To assess capsular bag and sulcus intraocular lens (IOL) centration in eyes that had implantation of a sulcus-fixated supplementary IOL anterior to a preexisting capsular bag IOL. SETTING: Academic Teaching Hospital of St. John, Vienna, Austria. DESIGN: Retrospective case series. METHODS: A sulcus-fixated supplementary IOL (Sulcoflex) was implanted anterior to a preexisting capsular bag IOL. The geometric center of preexisting capsular bag IOLs and newly implanted sulcus-fixated IOLs was evaluated at least 12 months postoperatively and in relation to the geometric center of the pupil and limbus. RESULTS: The study comprised 48 eyes of 43 patients with a mean follow-up of 25 months (range 12 to 84 months). The mean decentration of the capsular bag-fixated IOL was 0.29 mm ± 0.02 (SEM) when compared with the limbus and 0.29 ± 0.03 mm when compared with the dilated pupil. The mean decentration of the sulcus-fixated IOL was 0.23 ± 0.02 mm in relation to the limbus and 0.22 ± 0.02 mm when in relation to the dilated pupil. Sulcus-fixated supplementary IOLs showed significantly better centration than bag-fixated IOLs when compared with the limbus and with the pupil (both P = .03, paired t test). CONCLUSIONS: Implantation of a sulcus-fixated supplementary IOL resulted in good centration of capsular bag-fixated IOLs and ciliary sulcus-fixated IOLs. However, ciliary sulcus-fixated IOLs achieved significantly better centration.

Intraindividual comparison of capsule behavior of 2 hydrophobic acrylic intraocular lenses during a 5-year follow-up.

PURPOSE: To evaluate and compare the 5-year postoperative anterior (ACO) and posterior capsule opacification (PCO), the occurrence of glistenings, and the level of anterior capsule retraction after implantation of 2 designs of 1-piece hydrophobic acrylic IOLs. SETTING: Hospital St. John, Vienna, Austria. DESIGN: Randomized controlled prospective case series. METHODS: Patients had an Acrysof SA60AT IOL (Group A) implanted in 1 eye and a Tecnis ZCB00 IOL (Group B) implanted in the fellow eye. At 1, 3, and 5 years, the PCO level was evaluated with the Evaluation of Posterior Capsule Opacification software. The level of ACO and capsule retraction was graded subjectively. Glistenings were scored as present or not present. RESULTS: Fifty eyes of 25 patients were evaluated after 5 years. No significant differences in PCO scores were found between the 2 groups at all follow-up visits (1 year: 0.06 ± 0.12 [SD] versus 0.07 ± 0.13, P = .35; 3 years: 0.23 ± 0.36 versus 0.22 ± 0.32, P = .66; 5 years: 0.36 ± 0.41 versus 0.36 ± 0.54, P = .98). A significant increase in PCO score was found between 3 and 5 years (P < .01). Anterior capsule opacification was present in Group A and Group B in 18.0% and 2.7% of eyes (P = .03), in 92.0% and 24.0% of eyes, and in 100% and 52% of eyes (P < .01) at 1, 3, and 5 years, respectively. Glistenings (5 years 100%) were observed in Group A. CONCLUSION: Both IOLs had a comparable PCO rate 5 years after surgery, although more ACO and retraction as well as glistenings were observed in Group A.

Regression of epiretinal membrane after optic nerve atrophy.

PURPOSE: To describe a case of epiretinal membrane (ERM) regression after optic nerve atrophy. METHODS: Retrospective case report. RESULTS: A 56-year-old man with progressive visual impairment was found to have an ERM with associated retinal thickening and distortion (documented with spectral-domain optical coherence tomography [OCT]). In addition, we noted a slight unilateral paleness of the optic nerve. The patient denied any further diagnostic investigation and presented himself again 2 years after the initial presentation. A new OCT examination at this point revealed a remarkable regression of the ERM and atrophy of the retinal nerve fiber layer. CONCLUSIONS: Regression of ERM may occur after optic nerve atrophy. A potential causal linkage is suggested based on the atrophy of the retinal nerve fibers and regression of the glial cells.

Changes in straylight and densitometry values after corneal collagen crosslinking.

PURPOSE: To evaluate the change in backward-directed and forward-directed corneal straylight in eyes after corneal collagen crosslinking (CXL) and its correlation with corrected distance visual acuity (CDVA) and changes in corneal topography. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Retrospective cohort study. METHODS: Following the Dresden protocol, corneal CXL was performed in eyes with progressive keratoconus. Corneal light scattering was evaluated using densitometry measurements from different corneal layers and zones obtained using Scheimpflug tomography (Pentacam HR). Retinal straylight values were measured using the C-Quant device. The CDVA was recorded during each follow-up examination. Changes in corneal topography were measured using Scheimpflug tomography. RESULTS: The study evaluated 31 eyes of 31 patients. The mean densitometry of different corneal layers and in 3 different zones increased 3 months postoperatively and decreased thereafter. The mean densitometry in the 0.0 to 2.0 mm zone remained statistically significantly elevated after 12 months (P < .05). The mean preoperative retinal straylight was 1.14 log(s) ± 0.28 (SD). The mean straylight peaked after 1 month and then decreased continuously but remained elevated after 1 year at 1.26 ± 0.21 log(s). There was an increase in CDVA and flattening of the steepest keratometry (K) value (maximum K). Eyes with the greatest maximum K reduction also had the highest densitometry values. CONCLUSIONS: Crosslinking-induced stromal changes resulted in an increase in densitometry, especially in the anterior stroma of the central (0.0 to 2.0 mm) zone. These changes correlated with an increase in retinal straylight but not with the postoperative CDVA values.

Pachymetry changes during corneal crosslinking: effect of closed eyelids and hypotonic riboflavin solution.

PURPOSE: To evaluate pachymetry changes during standard corneal crosslinking (CXL) and the effect of closed eyelids and hypotonic riboflavin in thin corneas. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. DESIGN: Comparative case series. METHODS: Eyes with progressive keratoconus had standard epithelium-off CXL. In Group 1, a lid speculum was used during the procedure. In Group 2, the lids were closed during saturation with riboflavin. In Group 3, hypotonic riboflavin was used. In Groups 1 and 2, swelling was performed with hypotonic riboflavin if pachymetry was less than 400 µm. The thinnest corneal pachymetry (TCP) was measured preoperatively, after epithelium removal, and every 10 minutes thereafter. RESULTS: Thirty-five eyes were evaluated. After epithelium removal, the mean TCP was 401 µm ± 15 (SD), 411 ± 35 µm, and 400 ± 24 in Groups 1, 2, and 3, respectively. In Group 1, the TCP decreased to 355 ± 23 µm after the first 30 minutes. In Group 2, the TCP remained stable throughout the saturation phase. In Group 3, the TCP increased. During the irradiation phase, a reduction in pachymetry occurred in all groups. Thinnest corneal pachymetry readings less than 400 µm were found in all eyes irrespective of the protocol. CONCLUSIONS: Corneal desiccation with riboflavin with 20% dextran can be avoided when removing the lid speculum during saturation with riboflavin. The use of hypotonic riboflavin solution increased corneal pachymetry, although the final TCP remained unchanged. To increase endothelial safety, new isooncotic solutions are needed.

Effects of orally administered moxaverine on ocular blood flow in healthy subjects.

BACKGROUND: To investigate the effect of orally administered moxaverine (Kollateral forte®) on ocular blood flow in young healthy subjects. METHODS: Sixteen healthy subjects (eight male/eight female) aged between 20 and 32 years were included in this placebo-controlled, double-masked, two-way crossover study. Volunteers received 900 mg moxaverine-hydrochloride administered orally in three equal doses or placebo identical in appearance on 2 study days. Outcome variables were measured at baseline and 5 h after first drug administration. Laser Doppler flowmetry was used to assess choroidal and optic nerve head blood flow. Blood velocities in the retrobulbar vessels were measured with color Doppler imaging. RESULTS: Neither moxaverine nor placebo changed mean arterial pressure or intraocular pressure. Neither moxaverine nor placebo had an effect on choroidal (moxaverine: by 9.5 ± 17.2 %, placebo 3.8 ± 18.8 %, p = 0.54 between groups) or optic nerve head blood flow (moxaverine: 4.8 ± 10.4 %, placebo: 1.8 ± 10.9 %, p = 0.52 between groups). Similarly, administration of moxaverine did not change blood flow velocities or calculated resistance index in the retrobulbar vessels compared to placebo. CONCLUSION: The data of the present study indicate that orally administered moxaverine does not increase ocular blood flow. This is in contrast to previous findings, where parenteral administration of moxaverine lead to a significant increase in choroidal blood flow and blood flow velocities in the retrobulbar vessels. The reason for these differing results is unclear, but may be related to the low bioavailability after oral administration.

Morphologic characteristics of idiopathic juxtafoveal telangiectasia using spectral-domain and polarization-sensitive optical coherence tomography.

PURPOSE: Idiopathic juxtafoveal telangiectasia (IJT) is characteristically associated with pigmentary changes. Polarization-sensitive spectral-domain optical coherence tomography (PS-SD-OCT) enables imaging of the retinal pigment epithelium (RPE) and similar melanin-containing structures based on specific polarization properties. This study examined IJT with the latest-generation SD-OCT and PS-SD-OCT, identifying pathophysiologically relevant characteristics of the retinal layers and RPE. METHODS: Twenty-two eyes of 12 patients with IJT were examined by PS-SD-OCT, with special focus on RPE detection and segmentation. Furthermore, SD-OCT technology (Cirrus, Spectralis, and 3D-OCT-1000) was applied. Characteristics of the retinal layers and RPE were evaluated. A classification system based on OCT characteristics of IJT was suggested. RESULTS: Polarization-sensitive spectral-domain optical coherence tomography together with SD-OCT identified characteristic patterns of IJT, used to classify eyes into three distinct groups. Group 1 (5 eyes) revealed discrete alterations in the inner retinal layers; group 2 (12 eyes) showed irregularities of the junction between the inner and outer photoreceptor segments with outer retinal atrophy but an intact RPE. Group 3 (5 eyes) revealed RPE irregularities and loss in addition to intraretinal alterations and photoreceptor abnormalities. CONCLUSION: This study described characteristic morphologic changes in IJT based on PS-SD-OCT and SD-OCT. Morphologic changes were classified, possibly leading to an OCT-based grading scheme. The intensity images of SD-OCT verified intraretinal and photoreceptor irregularities in great detail, whereas PS-SD-OCT additionally showed RPE alterations.

Effect of intravitreal bevacizumab (Avastin) in neovascular age-related macular degeneration using a treatment regimen based on optical coherence tomography: 6- and 12-month results.

PURPOSE: To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age-related macular degeneration (AMD) within a follow-up period of 6 and 12 months. METHODS: A retrospective analysis of 102 eyes of 102 consecutive patients with neovascular AMD evaluated repeated intravitreal bevacizumab (1 or 2.5 mg) injections. Retreatment was performed following an optical coherence tomography (OCT)-based regimen. Ophthalmic examination included best-corrected visual acuity (BCVA), dilated fundus examination and OCT imaging. Data were analysed at baseline, 6 months (24 weeks) and 12 months (48 weeks) after treatment initiation. RESULTS: BCVA remained stable at 6 months (mean: 0.00+/-0.41 logMAR; p=0.95) and 12 months (mean: +0.02+/-0.43 logMAR; loss of approximately 1 letter; p=0.70) after the first treatment. OCT retinal thickness decreased by a mean of -37.8+/-101.6 microm (p<0.05) compared to baseline at month 6 and -38.6+/-93.3 microm (p<0.05) at month 12. A mean of 2.6+/-1.2 injections were needed to obtain absence of fluid by OCT, and the time to recurrence was 23+/-11 weeks thereafter. There was no difference in BCVA and OCT outcomes between treatment-naive eyes and eyes that had undergone prior treatment. CONCLUSION: The 6- and 12-month follow-up of repeated intravitreal bevacizumab therapy in eyes with neovascular AMD demonstrated stabilization of vision and no safety concerns. An OCT-based retreatment strategy appears appropriate in the management of patients treated with intravitreal bevacizumab.

Imaging of the retinal pigment epithelium in age-related macular degeneration using polarization-sensitive optical coherence tomography.

Purpose. Spectral-domain optical coherence tomography (SD-OCT) provides new insights into the understanding of age-related macular degeneration (AMD) but limited information on the nature of hyperreflective tissue at the level of the retinal pigment epithelium. Therefore, polarization-sensitive (PS) SD-OCT was used to identify and characterize typical RPE findings in AMD. Methods. Forty-four eyes of 44 patients with AMD were included in this prospective case series representing the entire AMD spectrum from drusen (n = 11), geographic atrophy (GA; n = 11), neovascular AMD (nAMD; n = 11) to fibrotic scars (n = 11). Imaging systems were used for comparative imaging. A PS-SD-OCT instrument was developed that was capable of recording intensity and polarization parameters simultaneously during a single scan. Results. In drusen, PS-SD-OCT identified a continuous RPE layer with focal elevations. Discrete RPE atrophy (RA) could be observed in two patients. In GA, the extension of the RA was significantly larger. Residual RPE islands could be detected within the atrophic zone. PS-SD-OCT identified multiple foci of RPE loss in patients with nAMD and allowed recognition of advanced RPE disease associated with choroidal neovascularization. Wide areas of RA containing residual spots of intact retinal pigment epithelium could be identified in fibrotic scars. Conclusions. PS-SD-OCT provided precise identification of retinal pigment epithelium in AMD. Recognition of these disease-specific RA patterns in dry and wet forms of AMD is of particular relevance to identify the status and progression of RPE disease and may help to better estimate the functional prognosis of AMD.

Association of retinal sensitivity and morphology during antiangiogenic treatment of retinal vein occlusion over one year.

PURPOSE: Evaluation of the association between functional and anatomic retinal changes during anti-vascular endothelial growth factor (VEGF) therapy with bevacizumab (Avastin) in patients with cystoid macular edema secondary to retinal vein occlusion (RVO) using microperimetry and spectral domain optical coherence tomography (SD-OCT). DESIGN: Prospective, uncontrolled study (EUDRACT NR-2005-003288-21). PARTICIPANTS: Twenty-eight patients with cystoid macular edema secondary to RVO. METHODS: Patients initially received 3 consecutive intravitreal injections of 1.25 mg bevacizumab at 4-week intervals. Further treatment was based on morphologic (OCT) and functional best-corrected visual acuity (BCVA) findings. During the 1-year follow-up, a rigorous standardized evaluation was performed monthly. Macular function was documented by microperimetry (Nidek, MP1 Microperimeter) and BCVA based on the Early Treatment in Diabetic Retinopathy Study (ETDRS). Morphologic parameters included central retinal thickness (CRT) as measured by conventional OCT (Stratus), and central subfield thickness (CST), mean retinal thickness (MRT), and retinal volume (RV) measured by SD-OCT. MAIN OUTCOME MEASURES: Imaging of retinal morphology using OCT and SD-OCT and evaluation of retinal function assessed with microperimetry and ETDRS charts during 12 months of anti-VEGF treatment. RESULTS: Within 6 months, the mean area of absolute scotoma was reduced from 21.4% of the central visual field to 6.4% and remained at this level until month 12 (7.4%). Mean BCVA improved from 51 to 66 letters on ETDRS charts. The CRT, CST, and MRT decreased significantly (P<0.002) and remained stable during the follow-up. The RV values did not improve significantly under therapy. Statistical analysis using a linear effects model revealed significant associations between the functional and morphologic outcomes, most notably between BCVA, macular sensitivity, CRT (Stratus OCT), CST, and MRT (Cirrus OCT) values. CONCLUSIONS: Central retinal morphology, especially CRT and CST measured by conventional and SD-OCT, and retinal function improved significantly during treatment of RVO with a flexible dosing regimen of intravitreal bevacizumab. Functional (central visual acuity and visual field) and morphologic parameters (retinal thickness) were significantly related. These associations highlight the value of OCT imaging for assessing this disease entity.

Intraocular concentrations of growth factors and cytokines in retinal vein occlusion and the effect of therapy with bevacizumab.

PURPOSE: To investigate concentrations of growth factors and inflammatory cytokines in eyes with central (CRVO) and branch (BRVO) retinal vein occlusion before and during therapy with bevacizumab and to identify associations with disease activity. METHODS: In a prospective clinical trial, 13 eyes of patients with CRVO (n = 5) or BRVO (n = 8) were included. Bevacizumab was administered intravitreously at baseline and months 1 and 2. Retreatments were given at monthly visits if OCT showed edema or when vision loss occurred. Aqueous humor samples were taken each time injections were performed. Follow-up was 15 months. Samples from patients with cataract served as the control. Multiplex bead assays were used for measurement of 28 growth factors and cytokines. RESULTS: During therapy with bevacizumab, VEGF levels were reduced to below detection in the first 2 months. Whenever criteria for retreatment were met, VEGF was measurable again. The decrease in VEGF was associated with a decrease in central retinal thickness (CRT) and improvement in visual acuity (VA). Significantly increased concentrations of VEGF, IL-6, IL-8, IP-10, MCP-1, and PDGF-AA were observed in aqueous humor samples of patients with CRVO compared with the control samples. CONCLUSIONS: VEGF levels were significantly elevated in patients with CRVO compared with control subjects. Intravitreal injections of bevacizumab resulted in a substantial decrease of VEGF under physiologic levels and remained low under the loading dose of three consecutive monthly retreatments. Macular edema was related to VEGF levels in the aqueous humor.

Comparison of 2.5 mg/kg and 5 mg/kg systemic bevacizumab in neovascular age-related macular degeneration: twenty-four week results of an uncontrolled, prospective cohort study.

BACKGROUND: To compare safety, visual acuity (VA), and anatomic outcomes of 2.5 mg/kg and 5 mg/kg intravenous bevacizumab in patients with neovascular age-related macular degeneration. METHODS: In an institutional cohort study, 16 patients (2 cohorts, 27 eyes) with neovascular age-related macular degeneration were treated with 5 mg/kg intravenous bevacizumab and 2.5 mg/kg, respectively. All patients received 3 initial intravenous infusions at 2-week intervals. The main outcome measures were VA, optical coherence tomography, and fluorescein angiography. RESULTS: No serious systemic or ocular adverse events were identified. By Day 7, mean VA increased from 56 letters (20/80(+1)) at baseline to 60 letters (20/63) in the 5 mg/kg group and mean central retinal thickness decreased by 83 microm. In the 2.5 mg/kg group, mean VA increased from 55 letters (20/80) to 66 letters (20/50(+1)) and mean central retinal thickness decreased by 93 microm. By Month 3, VA improved by 10 letters compared to baseline in the 5 mg/kg group and by 9 letters in the 2.5 mg/kg group. Central retinal thickness was reduced by 128 microm in the 5 mg/kg group and by 127 microm in the 2.5 mg/kg group. These benefits were sustained through 6 months. No statistically significant difference was found between both treatment groups regarding safety, VA, and anatomic outcomes. CONCLUSION: Similar VA, optical coherence tomography, and angiographic improvements were observed in both treatment groups up to 6 months. Further follow-up is required to evaluate the long-term durability and safety of both treatment regimens.

Changes in retinal sensitivity in patients with neovascular age-related macular degeneration after systemic bevacizumab (avastin) therapy.

OBJECTIVE: To evaluate changes in central retinal sensitivity in patients with neovascular age-related macular degeneration after systemic bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) therapy. METHODS: For all eyes, the central 12 x 12 degrees visual field was recorded using the MP 1 Microperimeter (Nidek, Gamagori, Japan) at baseline and 1 week, 1 month, 3 months, and 6 months after initial treatment. Patients received systemic anti-vascular endothelial growth factor (VEGF) therapy with three initial bevacizumab infusions at 2-week intervals. Retreatment during follow-up was performed only in cases of choroidal neovascularization recurrence. Seven patients (12 eyes) received bevacizumab infusions at a dose of 5 mg/kg, and 7 patients (9 eyes), at a dose of 2.5 mg/kg. RESULTS: Of 41 stimulation points, a mean absolute scotoma of 15 missed stimulation points was measured at baseline, which decreased to 10 missed stimulation points at month 3 (-5; P = 0.005) and to 11 stimulation points at month 6 (-4; P = 0.106). The mean absolute scotoma size (in % of total tested area) decreased from 33% to 22% (-11%; P = 0.011) at month 3 and to 23% (-10%, P = 0.123) at month 6. Mean differential light threshold increased significantly throughout the observation period from 3.8 dB at baseline to 5.5 dB (+1.7 dB; P = 0.012) at month 6. CONCLUSIONS: Systemic bevacizumab therapy induced a significant increase in mean retinal sensitivity at month 6 of follow-up and a significant decrease of mean absolute scotoma size at month 3. The MP 1 Microperimeter proved to be a valuable tool in the evaluation of functional benefits and retinal safety of anti-VEGF therapy with systemic bevacizumab.

Intravitreal bevacizumab therapy for neovascular age-related macular degeneration with large submacular hemorrhage.

PURPOSE: To evaluate functional and anatomic effects of intravitreal bevacizumab (Avastin; Roche Pharma, Vienna, Austria) in patients with neovascular age-related macular degeneration (AMD) with large submacular hemorrhages. DESIGN: Retrospective, clinical study. METHODS: Twenty-one eyes of 19 AMD patients with choroidal neovascularization and large submacular hemorrhage involving the fovea comprising more than 50% of the total lesion area were evaluated. All patients completed at least four months of follow-up; 12 patients fulfilled 12 months or more of follow-up. Patients were treated with up to six intravitreal bevacizumab injections (1 mg/0.04 ml) at a minimum of four-week intervals. Changes from baseline visual acuity (VA) scores, retinal measurements by optical coherence tomography (OCT), angiographic lesion characteristics, and hemorrhage size were analyzed. A safety assessment was performed at all visits. RESULTS: Intravitreal bevacizumab injections were well tolerated in all patients. At month 4, VA was stable or improved (visual loss of 3 acuity lines or fewer) in 100% and improved by at least 3 lines in 9.5%. Comparable results were found at month 12. On average, the central foveal thickness decreased significantly by 55 microm four weeks after the first injection (P < .001) and by 52 microm at month 4 (P = .002). A significant anatomic improvement also was found for maximum retinal thickness, minimum retinal thickness, and foveal volume (P < .05) and was maintained during four months of follow-up. Mean size of hemorrhage was significantly reduced from 19.7 mm(2) at baseline to 2.5 mm(2) at the four-month follow-up (P < .001). CONCLUSIONS: Intravitreal bevacizumab seems to be a promising therapeutic option in eyes with neovascular AMD and large submacular hemorrhages, with a stabilization in VA and anatomic improvement.

Retinal pigment epithelium tears following intravitreal ranibizumab therapy.

Two patients with choroidal neovascularization secondary to age-related macular degeneration (AMD) developed a retinal pigment epithelial (RPE) tear following intravitreal injection of ranibizumab. One patient developed the RPE tear within 2 weeks of the injection, the other within 6 weeks of a second injection. Both patients presented with vision loss of one line at diagnosis of the RPE tear. During long-term follow-up, visual acuity improved in one patient by one line and deteriorated in the second patient by three lines. RPE tears may occur after intravitreal injection of ranibizumab in patients with neovascular AMD, probably because of the rapid regression of the fibrovascular membrane.

Choroidal neovascularization secondary to Sorsby fundus dystrophy treated with systemic bevacizumab (Avastin).

PURPOSE: A case of choroidal neovascularization (CNV) secondary to Sorsby fundus dystrophy (SFD) treated with systemic bevacizumab (Avastin). METHODS: A 41-year-old woman presented with CNV secondary to SFD in her better eye. The patient received three initial infusions of bevacizumab at a dose of 5 mg/kg at 2 week intervals and one additional infusion because of CNV recurrence at the 7 month follow-up. RESULTS: At 16 month follow-up, visual acuity had improved from 20/50 at baseline to 20/25; optical coherence tomography and fluorescein angiography showed no evidence of CNV activity. CONCLUSION: Systemic bevacizumab seems to be a promising treatment option for CNV secondary to SFD.

Effect of systemic bevacizumab therapy on retinal pigment epithelial detachment.

BACKGROUND: To evaluate the effect of systemic bevacizumab (Avastin) therapy on pigment epithelial detachment (PED) secondary to age-related macular degeneration (AMD) and to identify prognostic factors for PED regression and improvement in best corrected visual acuity (BCVA). STUDY DESIGN: Prospective uncontrolled pilot study. METHODS: Nine patients (nine eyes) received three systemic bevacizumab treatments at 2 week intervals and were examined at baseline, weeks 1, 2, 4, 6 and month 3 by using optical coherence tomography (Stratus OC, Carl Zeiss Meditec, Dublin, California, USA). Changes in maximum PED height and greatest linear diameter (GLD) were planimetrically analysed by using Adobe Photoshop CS and correlated with retinal morphological changes and changes in BCVA. RESULTS: Systemic bevacizumab therapy was well tolerated. Mean maximum PED height decreased significantly by 21% as early as 1 week (-96 microm (SD 48.8), p<0.01). At 3 months follow-up, two PEDs resolved completely, mean maximum PED height decreased significantly by 39% (-179 microm (SD 178), p = 0.02) and mean PED GLD by 24% (-714 microm (SD 1010), p = 0.07). Mean BCVA improved significantly by week 2 (+8.7 letters (SD 5.7), p<0.01) and at 3 months with 12.7 letters (SD 6.4) (p<0.01). CONCLUSION: In the examined nine patients, systemic bevacizumab therapy showed evidence for an effect on PED secondary to neovascular AMD in terms of a decrease in lesion height and diameter. A high PED at baseline was found to be a negative predictive factor for visual outcome.

Evaluation of anterior chamber inflammatory activity in eyes treated with intravitreal bevacizumab.

PURPOSE: To evaluate the effect of intravitreal bevacizumab on anterior chamber inflammatory activity. METHODS: Sixty-one consecutive patients with neovascular age-related macular degeneration were examined before, 1 day, and 1 week after intravitreal administration of 1 mg of bevacizumab (0.04 mL) for neovascular age-related macular degeneration. The intravitreal injection was performed under sterile conditions. Twenty-one fellow eyes served as controls. The anterior chamber inflammatory activity was evaluated using biomicroscopy and the laser flare meter (Kowa FM-500, Kowa Company, Ltd., Tokyo, Japan). RESULTS: None of the 61 consecutive patients had a significant, clinically detectable inflammatory response within 1 week of follow-up. Anterior chamber inflammatory activity measured by the laser flare meter ranged from 1.9 counts/ms to 70.0 counts/ms (mean +/- SD, 13.2 +/- 16.9 counts/ms; 95% confidence interval [CI], 7.8-18.6) before treatment. One day and 1 week after injection, values were between 3.2 counts/ms and 30.0 counts/ms (mean +/- SD, 9.1 +/- 6.2 counts/ms; 95% CI, 7.2-11.1) and 2.0 counts/ms and 25.1 counts/ms (mean +/- SD, 7.3 +/- 4.6 counts/ms; 95% CI, 5.8-8.8), respectively. There was a significant reduction of anterior chamber flare at 1 week compared with baseline (P = 0.031). The control eyes had constantly low flare measures. CONCLUSION: No inflammatory response was detected clinically and by the laser flare meter after intravitreal bevacizumab administration. The slight reduction in anterior chamber flare could be due to the known antiinflammatory effect of anti-vascular endothelial growth factor therapy.