What is the role of bevacizumab in the treatment of central retinal vein occlusion (CRVO)?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Answer

Intravitreal Injection of bevacizumab

Bevacizumab (Avastin, Genentech, Inc.) is a recombinant, humanized monoclonal antibody that binds all isoforms of VEGF-A. Intravitreal injection of bevacizumab (0.05 mL/1.25 mg) has been shown to be effective not only in resolving the edema but also in corresponding improvement in vision. In a prospective, randomized, double-masked clinical study by Epstein et al, intravitreal injections of bevacizumab given every 6 weeks for 12 months improve visual acuity and significantly reduce edema compared with sham. Early treatment is important in these patients to optimize visual outcome, as patients in whom treatment is delayed have limited visual improvement. In addition, none of the patients developed neovascular glaucoma when treated with bevacizumab.

Bevacizumab is approved for treatment of various metastatic cancers, including metastatic colorectal cancer, non-small cell lung cancer, and glioblastoma multiforme. Intravitreal injection of bevacizumab is considered off-label use. Bevacizumab is not commercially available as an intravitreal injection. Reports of small series of eye infections due to contamination from repackaging into preservative-free single use vials have been reported.

Significant complications were reported with high doses of bevacizumab given intravenously for the treatment of cancer. There have been no significant reports of these complications when used in low dosage in eye. [18, 13, 41, 27, 42]

Intravitreal anti-VEGF injections yielded better anatomical and functional improvements than did corticosteroids. After initial improvements in visual acuity with anti-VEGF injections, some of those gains were lost over time because of recurrent macular edema. [43, 44]


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