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.

Licence for PublicationThe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BJO and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://bjo.bmj.com/ifora/licence.pdf).Competing Interest: None declared. BRVO) were enrolled in the study. Three intravitreal injections of 1 mg bevacizumab (0.04 ml) were administered at 4 week intervals; further retreatment was based on optical coherence tomography (OCT) findings. Follow-up examinations were done at days 1, 7 and 28 and at monthly intervals thereafter. Results: Mean baseline central retinal thickness (CRT) in OCT was 558 µm (range 353 to 928 µm) and mean BCVA was 20/100. One day after the first injection, CRT significantly decreased to 401 µm (p < 0.01). Three injections reduced macular edema to 328 µm CRT (p < 0

Aims: The aim of the study was to evaluate functional and anatomical changes after intravitreal bevacizumab (AvastinH) in eyes with persistent macular oedema secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Methods: Twenty-nine consecutive eyes with macular oedema secondary to BRVO (21 eyes) or CRVO (eight eyes) were included in a prospective clinical trial. Eyes were treated with three initial intravitreal bevacizumab injections of 1 mg at a monthly interval. Retreatment was based on central retinal thickness (CRT) based on optical coherence tomography. If continuous injections were indicated up to month 6, the dose was increased to 2.5 mg. Results: After 12 months of follow-up, mean visual acuity increased from 50 letters (20/100) at baseline to 66 letters (20/50 +1 ; +16 letters; p,0.001) at month 12 and CRT decreased from 558 mm at baseline to 309 mm at month 12 (2249 mm; p,0.001). Patients received a mean of eight out of 13 possible injections. No drugrelated systemic or ocular side effects following intravitreal bevacizumab treatment were observed. Fluorescein angiography revealed no progression of avascular areas. Conclusions: Intravitreal therapy using bevacizumab appears to be a safe and effective treatment in patients with macular oedema secondary to retinal vein occlusion. However, the main limitations of this treatment modality are its short-term effectiveness and high recurrence rate.With a cumulative 10-year incidence of 1.6%, retinal vein occlusion (RVO) is the most common retinal vascular disease after diabetic retinopathy. The most common sequela of RVO is the development of cystoid macular oedema (CMO) with a consecutive deterioration in vision. The major stimulus for the formation of macular oedema and neovascularisation in patients with RVO seems to be hypoxia-induced production of vascular endothelial growth factor (VEGF), an angiogenic factor that promotes angiogenesis and increases permeability. 6 The only proven treatment method for eyes with CMO secondary to BRVO is macular grid laser photocoagulation. However, according to the Branch Vein Occlusion Study, only patients with macular oedema associated with BRVO and a visual acuity of 20/40 or less showed a significant visual benefit compared with the untreated control group. 7 In patients with macular oedema secondary to CRVO, there was no difference between eyes treated with macular grid laser photocoagulation and observation only. Several studies have evaluated the efficacy of intravitreal triamcinolone in the treatment of macular oedema secondary to both BRVO and CRVO, but were only able to show stabilisation or a moderate improvement in visual acuity. 9-11However, the main limitation of intravitreal triamcinolone therapy is the high rate of side effects, such as cataract formation or increased intraocular pressure.An alternative for patients with macular oedema secondary to RVO is anti-VEGF therapy. Since the first report of the efficacy of intravitreal bevacizumab (a recombinant mon...

Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection. Patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage. Vitreous haemorrhage and infectious endophthalmitis might be differentiated by time course and symptoms.

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.