Bevacizumab, Ranibizumab Improve Vision in Choroidal Osteoma

Pam Harrison

August 26, 2013

TORONTO, Ontario — Intravitreal bevacizumab or ranibizumab can be effective in choroidal neovascularization (CNV) over several years of follow-up, suggests the largest study of its kind.

"One of the side effects of choroidal osteoma is that it can cause new vessel formation under the retina, with loss of vision," Ahmad Mansour, MD, from the American University of Beirut in Lebanon, told Medscape Medical News. "By injecting antivascular endothelial growth-factor [VEGF] agents early on, we can stop this process from occurring. Since we are often talking about very young patients with this disease, losing vision so early on can be very serious."

Dr. Mansour reported the findings here at the 31st Annual Meeting of the American Society of Retina Specialists.

For this retrospective multicenter study, investigators injected a total of 26 eyes from 25 patients. The mean age of the cohort was 30 years, but some patients were children 10 years and younger. Injections were given intermittently as 3 initial consecutive doses or were based on optical coherence tomography responses. Photodynamic therapy was administered in some eyes as well.

 
If you treat early and aggressively, this is the best treatment to preserve vision in these young patients.
 

Mean outcomes were changes in best-corrected visual acuity and in central foveal thickness. Bevacizumab was injected in approximately two thirds of patients, with a mean of 3 injections in the first year and a mean of 6 injections in the second year.

At baseline, the mean central foveal thickness was 447 microns. Mean central foveal thickness was 339 microns 6 months after the anti-VEGF injections; this continued to drop to a mean of 265 microns at 24 months. At all time points, the mean decrease in central foveal thickness from baseline was clinically significant.

In addition, best-corrected visual acuity improved by more than 3 lines at 6 months, which is "an extremely impressive response," Dr. Mansour noted.

Table. Improvement After Treatment With Bevacizumab or Ranibizumab

Mean Outcome 6 Months 12 Months 18 Months 24 Months
Decrease in central foveal thickness from baseline (microns) 119.7 105.3 23.5 157.6
Improvement in visual acuity (lines) 3.3 2.8 2.0 3.1

 

In eyes treated with concomitant anti-VEGF injections and photodynamic therapy, best-corrected visual acuity improved by 3.9 lines at 6 months (= .04).

No systemic or ocular adverse effects were observed in the overall cohort, Dr. Mansour pointed out. The number of injections required to control CNV over the follow-up interval was variable, with some patients requiring only a few injections and others requiring significantly more, he explained.

"In general, the bigger or thicker the tumor, the more aggressive it is," Dr. Mansour explained. "If it is growing, the tumor secretes more growth factors" and requires more anti-VEGF injections to control. Historically, choroidal osteomas were treated with either focal lasers or with photodynamic therapy.

However, Dr. Mansour noted, there is a high recurrence rate after focal laser therapy, and photodynamic therapy causes decalcification and atrophy of the fovea, with potential loss of vision.

 
Choroidal osteomas are very rare — it took 26 centers for me to collect these cases.
 

"Choroidal osteomas are very rare — it took 26 centers for me to collect these cases. We might see only 1 case every decade," Dr. Mansour said. "If you treat early and aggressively, this is the best treatment to preserve vision in these young patients, and the complication rate is minimal."

Commenting on the study, meeting delegate and speaker Carol Shields, MD, from the Wills Eye Institute and Thomas Jefferson University in Philadelphia, pointed out that this is the largest group of patients with CNV ever reported.

"At Wills, we've seen the same thing — intravitreal anti-VEGF is the way to go when a patient has CNV from an osteoma," she said.

However, she cautioned against using photodynamic therapy if the patient has a subfoveal osteoma "because you will decalcify the osteoma, and that can lead to reduced vision."

Dr. Mansour and Dr. Shields have disclosed no relevant financial relationships.

31st Annual Meeting of the American Society of Retina Specialists. Presented August 24, 2013.

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