Abstract

SO.11.09

OCT guided re-injection of 2.5mg bevacizumab for treatment of macular edema due to retinal vein occlusion

Höh A. E., Schaal K. B., Dithmar S.
Department of Ophthalmology, University of Heidelberg

Objective: Macular edema (ME) due to retinal vein occlusion can be successfully treated with intravitreal bevacizumab therapy. There is no common consent concerning time intervals of reinjection and when recurrence of ME should be expected.
Methods: Prospective study. Patients with persistent ME (>250μm) due to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) receive intravitreal bevacizumab 2,5mg/0,1ml as off-label therapy. Reinjections are only performed if OCT shows persistent or recurrent ME. Visual acuity (EDTRS), ophthalmic examination and OCT are performed at baseline and at 6-week intervals.
Results: 33 patients have been included in the study so far with a mean follow-up of 22±12 weeks. In 16 patients (6 CRVO, 10 BRVO) ME had completely resolved 6 weeks after first injection (mean change in visual acuity 3,7±2,7 lines). 68,8% (n=11) of these patients developed a recurrence of ME within 10,8±4,2 weeks after first injection. In 5 patients ME did not recur within 12,0±4,2 weeks. All patients with recurrence of ME received a second injection that completely resolved ME within 6 weeks, the visual acuity gained the same level as after first injection (difference in visual acuity: 0,3±1,9 lines). Another relapse of ME in this group occurred in 89% (n=8) of patients 17,0±6,5 weeks (9-28 weeks) after second injection.
Patients who had persistent ME after first injection (n=17) received a second injection, initially leading to a complete reduction of ME in 41,2% (n=7), but all of these patients showed another relapse within 9,6±4,3 weeks.
No intraocular or systemic side effects were observed.
Conclusions: Intravitreal bevacizumab therapy of retinal vein occlusions by OCT guided re-injection does lead to anatomic and functional stabilisation or improvement even if transient recurrence of ME occurs and can minimize the number of injections needed in comparison to a strict re-injection scheme.
Supported by Gertrud Kusen Foundation (Di 2007)

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