Role of Avastin in management of central serous chorioretinopathy

Abstract

Purpose: To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC).

Design: Prospective interventional series non-comparative study.

Setting: Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt.

Methods: The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6 months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25 mg (0.05 mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1-3 injections) 6-8 weeks intervals and follow up for 6 months (range 5-7 months). All finding at baseline and each follow up visit were reported and compared.

Results: The mean age of all patients was 40.3 years ± 6.5 (range 25-50 years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change (P < 0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change (P < 0.002). The mean baseline CRT for all patients was 486 ± 86 μm (range, 386-580), decreased to 316 ± 56 μm (range, 276-368) after 1 months with statistically significance difference change (P < 0.02) and to 272 ± 52 μm (range 220-338) at last follow up with statistically significance difference change from the baseline (P < 0.001).

Conclusions: Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.

Keywords: Avastin (bevacizumab); Central serous chorioretinopathy; FA; Intravitreal injection; OCT.

Figure 1

(A) Colored fundus photography of Rt. acute CSC at baseline. (B) OCT of the same patient with sensory retinal detachment and subretinal fluid and increased CRT = 480 μm at baseline. (C) OCT of the same patient with incomplete or partial resolution of subretinal fluid and decreased CRT = 280 μm after 1 month of IVA injection. (D) OCT of the same patient with complete resolution of subretinal fluid and decreased CRT = 240 μm after 1 month of the second IVA injection at the end of follow up.

Figure 2

Colored fundus photography of Rt., eye with recurrent CSC at baseline, subretinal fluid was turbid.

Figure 3

(A) Colored fundus photography of Lt., eye with chronic CSC showing RPE atrophy at baseline. (B) FA, of the same case showing granular hyperfluorescence with many decompensatory leaks and two macular leaking spots in venous phase. (C) FA of the same case with fading in late stage.

Figure 4

(A) FA, of acute case of CSC with active central leaking hyperfluorescent spot. (B) FA, of the same case with enlargement of the leaking spot. (C) FA, of the same case with more leaking, enlargement and smoke stack formation. (D) FA, of the same case with resolution of the leaking spot after 2 weeks of IVA injection.

Figure 5

Graph for CRT over follow up time.

Figure 6

Graph for BCVA over follow up time.