Title: Role of Intravitreal Bevacizumab for the Treatment of Acute Central Serous Chorioretinopathy

Authors: Parvez Ahmad Bhat, Arsalan Un Nisa, Shiraz Ahmad Bhat

 DOI: https://dx.doi.org/10.18535/jmscr/v8i7.40

Abstract

Purpose:  To find out the role of intravitreal bevacizumab in the treatment of acute central serous chorioretinopathy (CSC).

Methods:  A total of 24 patients of CSC were included in this study and were divided into two groups with 12 patients each. Treatment group received a single intravitreal injection of bevacizumab (1.25mg/0.05ml; Avastin) and in other group no treatment was given and served as control group. Central maculat thickness (CMT) and best corrected visual acuity (BCVA) were measured at baseline, 6 weeks,10 weeks,18 weeks and 24 weeks and were compared between treatment and control groups.

Results: Mean CMT in treatment group at baseline was 507.92±81.37µ (range: 380-630µ) which improved to 392.17±65.63µ (p value-0.000) at 6 weeks; 344.67±59.93µ (p value-0.000) at 12 weeks; 296.83±39.93µ (p value-0.000) at 18 weeks and 269.75±30.85µ (p value-0.000) at 24 weeks after injection. Baseline BCVA in treatment group was 0.58 log MAR units which improved to 0.44 log MAR (p value-0.000) at 6 weeks; 0.33 log MAR (p value-0.000) at 12 weeks; 0.26 log MAR (p value-0.000) at 18 weeks and 0.12 log MAR (p value-0.000) at 24 weeks after injection.  Mean  CMT in control group at baseline was 505.92±123.78µ (Range: 310-670µ) which improved to 398.67±79.23µ (p value-0.000) at 6 weeks; 360.42±73.37µ (p value-0.000) at 12 weeks; 324.67±56.36µ (p value-0.000) at 18 weeks and 293.83±83µ (p value-0.000) at 24 weeks after injection. Mean baseline BCVA in control group was 0.57 log MAR units which improved to 0.47 log MAR (p value-0.000) at 6 weeks; 0.37 log MAR (p value-0.000) at 12 weeks; 0.27 log MAR (p value-0.000) at 18 weeks and 0.175 log MAR (p value 0.000) at 24 weeks after injection. On comparison of CMT and BCVA at baseline and different follow-ups, between the two groups, no statistically significant difference was seen.

Conclusion: In this study we found that there was no benefit of intravitreal bevacizumab  over observation in the management of acute CSC.

Keywords: central serous chorioretinopathy (CSC), best corrected visual acuity (BCVA), central macular thickness (CMT), photodynamic therapy (PDT), optical coherence tomography (OCT), fundus fluorescein angiography (FFA).

References

  1. Hayashi K, Hasegawa Y, Tokoro T: Indocyanine green angiography of central serous chorioretinopathy. Int Ophthalmol 1986; 9: 37–41
  2. Stanga PE, Lim JI, Hamilton P: Indocyaninegreen angiography in chorioretinal diseases: indications and interpretation: an evidence based update. Ophthalmology 2003; 110: 15–21
  3. Menchini U, Virgili G, Lanzetta P, Ferrari E: Indocyanine green angiography in central serous chorioretinopathy. Int Ophthalmol .1997; 21: 57–69.
  4. Guyer DR, Yannuzzi LA, Slakter JS, Sorenson JA, Ho A, Orlock D: Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol 1994; 112: 1057–1062.
  1. Weis SM, Cheresh DA: Pathophysiological consequences of VEGF-induced vascular permeability. Nature 2005; 437: 497–504.
  2. Niegel MF, Schrage NF, Christmann S, Degenring RF: Intravitreal bevacizumab for chronic central serous chorioretinopathy (in German). Ophthalmologe 2008; 105: 943–945.
  3. Wang MS, Sander B, Larsen M: Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol 2002; 133: 787–793.
  4. Wang M, Sander B, la Cour M, Larsen M: Clinical characteristics of subretinal deposits in central serous chorioretinopathy. Acta Ophthalmol Scand 2005; 83: 691–696.
  5. Ober MD, Yannuzzi LA, Do DV, et al: Photodynamic therapy for focal retinal pigment epithelial leaks secondary to central serous chorioretinopathy. Ophthalmology 2005; 112: 2088–2094.
  6. Burumcek E, Mudun A, Karacorlu S, et al: Laser photocoagulation for persistent central serous retinopathy: results of long-term follow- up. Ophthalmology 1997; 104: 616 -622.
  7. Kanyange ML, De Laey JJ: Long-term follow- up of central serous chorioretinopathy (CSCR). Bull Soc Belge Ophtalmol 2002; 284: 39–44.
  8. Mennel S, Peter S, Meyer CH, et al: Effect of photodynamic therapy on the function of the outer blood-retinal barrier in an in vitro model. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1015–1021.

Corresponding Author

Parvez Ahmad Bhat