Intravitreal Bevacizumab (Avastin) for the Treatment of Cystoid Macular Edema in Behçet Disease

Mirshahi, Ahmad; Namavari, Abed; Djalilian, Ali R.; Moharamzad, Yashar; Chams, Hormoz

doi:10.1080/09273940802553295

Cited by 31 publications

(13 citation statements)

References 35 publications

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“…Four articles reported a statistically significant improvement in visual acuity at the end of the follow-up period,28 30 34 35 and four articles reported no change in visual acuity 29 32 33 36. Five of the case series found a statistically significant decrease in central retina thickness as measured by optical coherence tomography (OCT),28–30 33 34 while three series observed no change in central retinal thickness 32 35 36. Both visual acuity and OCT thickness were noted to improve in the isolated case report 31.…”

Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

“…Seven of these were case series, three prospective28 30 35 and five retrospective,29 32–34 36 and one was an isolated case report 31. All published reports included small numbers of patients, ranging from one to 27, with the follow-up period ranging from 1 week to 1 year.…”

Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

“…Standardised criteria for defining disease activity have been established by the Standardization of Uveitis Nomenclature (SUN) working group 41. In many reports where anti-VEGF therapy was used for refractory CMO in the setting of inactive uveitis, the definition of ‘inactive’ was not stated 32 33 35. Hence, it is difficult to know if the inflammation was truly inactive in these cases.…”

Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

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Vascular endothelial growth factor inhibition in uveitis: a systematic review

Gulati

Forooghian

Lieberman

et al. 2010

British Journal of Ophthalmology

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Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of uveitic complications such as cystoid macular oedema (CMO), choroidal neovasularisation (CNV) and retinal neovascularisation (RNV). The use of intravitreal anti-VEGF therapies, namely bevacizumab and ranibizumab, has recently been described in the treatment of these complications. Evidence describing the use of intravitreal anti-VEGF therapy for these complications consists of case reports and case series, most of which are retrospective and have limitations in design and analysis. As such, the current level of evidence supporting the use of intravitreal anti-VEGF therapy for these complications of uveitis would be rated as very low. Furthermore, blockage of VEGF has not been shown to have an anti-inflammatory effect. Thus, treatment of the underlying inflammatory disease should play a central role in the management of uveitic CMO, CNV and RNV. A two-pronged treatment regimen that focuses on achieving disease quiescence through the use of corticosteroids and/or immunosuppressive agents, while treating complications that arise despite adequate disease quiescence with intravitreal anti-VEGF agents, may be useful. However, further data from prospective controlled trials are needed before the therapeutic role of anti-VEGF therapy in the uveitis treatment regimen can be fully determined.

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Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

Section: Vegf Inhibition For the Treatment Of Uveitic Cmomentioning

confidence: 99%

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Vascular endothelial growth factor inhibition in uveitis: a systematic review

Gulati

Forooghian

Lieberman

et al. 2010

British Journal of Ophthalmology

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“…In this investigation, 12 eyes of 11 patients underwent an intravitreal injection of bevacizumab. The results were encouraging showing a BCVA improvement in 7 eyes (58%), although the FT and macular volume, measured with OCT, did not reveal a statistically significant difference with respect to the baseline values [40]. More studies are needed to assess the value of the anti-VEGF approach in the therapy of ME secondary to Behçet's disease.…”

Section: Behçet's Diseasementioning

confidence: 92%

Antivascular Endothelial Growth Factors for Inflammatory Chorioretinal Disorders

Parodi

Iacono

Verbraak³

et al. 2010

Anti-Vegf

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Macular edema (ME) and choroidal neovascularization (CNV) can complicate the course of several inflammatory chorioretinal diseases, leading to a severe visual function impairment. The most frequently involved clinical entities include for example multifocal choroiditis, presumed ocular histoplasmosis syndrome, Beçhet's disease, multiple evanescent white dot syndrome, birdshot chorioretinopathy, acute multifocal posterior placoid pigment epitheliopathy, serpiginous choroiditis, and persistent placoid maculopathy. Results that have reported on antivascular endothelial growth factor (anti-VEGF) treatment in uveitic patients with CNV or ME have demonstrated positive results in many cases. However, bearing in mind that it has been proven impossible to perform randomized clinical trials with anti-VEGF in uveitic patients with CNV or ME, further studies with longer follow-ups are necessary to assess the value of this therapeutic approach.

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“…In a study of Behçet patients treated with bevacizumab, visual acuity significantly improved in 7/12 eyes and remained unchanged in 5/12 eyes, but no significant improvements were noted on OCT and FA. 61 Ranibizumab was used in 6 patients with inflammatory ME and a beneficial effect on retinal thickness and visual acuity after 6 months was documented. 62 Due to the transient effect of anti-VEGF intraocular injections, this treatment modality is not suitable for ME in active chronic uveitis, but might be valuable in patients with a uveitis in remission and persistent ME.…”

Section: Anti-vascular Endothelial Growth Factor (Anti-vegf) Treatmentmentioning

confidence: 99%

Clinical Review: Update on Treatment of Inflammatory Macular Edema

Norel

Rothová

2010

Ocular Immunology and Inflammation

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The aim of this review is to summarize the recent developments in the treatment of inflammatory macular edema (ME). Inflammatory ME represents a major cause of visual loss in uveitis and its adequate management is crucial for the maintenance of useful vision in patients with uveitis. Recent studies favor early treatment of inflammatory ME, even in patients with full visual acuity. After recapitulating the standard treatment modalities for inflammatory ME the authors address novel corticosteroid implants. They review the literature on the efficacy of anti-VEGF agents for inflammatory ME and point out their beneficial, but transient effects. Further, they present recent data on the value of systemic biologics in uveitic ME and evaluate the effectiveness of vitrectomy. Finally, they propose an algorithm for the treatment of inflammatory ME and point out that the individual risk-benefit ratio, especially with systemic immunosuppressive therapy, should always be considered.

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Intravitreal Bevacizumab (Avastin) for the Treatment of Cystoid Macular Edema in Behçet Disease

Abstract: The intravitreal injection of Avastin could be effective in the improvement of the vision in patients with uveitis secondary to Behçet disease.

Cited by 31 publications

References 35 publications

Vascular endothelial growth factor inhibition in uveitis: a systematic review

Vascular endothelial growth factor inhibition in uveitis: a systematic review

Antivascular Endothelial Growth Factors for Inflammatory Chorioretinal Disorders

Clinical Review: Update on Treatment of Inflammatory Macular Edema

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