Vitrectomy does not Cure Bevacizumab Induced Uveitis

Shanmugam, P Mahesh; Rajesh, Rajesh; Kumar, Madhu

doi:10.5005/jp-journals-10020-1008

Cited by 1 publication

(1 citation statement)

References 9 publications

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“…We have found that vitrectomy does not cure bevacizumab induced vitritis and the vitreous inflammation persists until the bound anti-VEGF agent is eliminated from the eye, which may take 6 weeks or longer. 10 Bevacizumab induced vitritis responds to systemic steroids and this would be the preferred initial treatment in this patient. Intravitreal antibiotics are not necessary and intravitreal steroid is an alternate option to systemic steroid, provided the patient does not have elevated intraocular pressure.…”

Section: How Would One Manage the Patient Furthermentioning

confidence: 91%

Anti-VEGF Therapy - Managing Challenging Case Scenarios

Anand¹

2014

Delhi Journal of Ophthalmology

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The management of ocular neovascular diseases received a major shot in the arm with the advent of anti-VEGF (vascular endothelial growth factor) therapy at the turn of the millennium. The anti-VEGF triumvirate-bevacizumab (Avastin), ranibizumab (Lucentis) and Pegaptanib sodium (Macugen), especially the former two, constitute the bulk of therapy for exudative and neovascular retinal pathologies. 1-6 The use of these agents have brought along with them challenges and conundrums of their own. We have a few such challenging clinical scenarios with eminent experts providing their take and therapeutic strategies. Anand Rajendran-Case I: AMD CNVM with an RPE rip: A 72-year old male was being treated for a large CNVM secondary to AMD in the right eye. Having received an intravitreal injection bevacizumab (1.25mg) a month earlier, the patient received a second injection. The best corrected vision at this point was 20/200 (the same as the previous month) [Figure 1a,1b]. Post-treatment the patient presented with a large RPE rip, increased serous detachment and a drop in vision to 20/300 [Figure 1c, 1d]. What would be the course of management?: A. Observation B. Continued intravitreal bevacizumab C. Continued anti-VEGF, but a switch to ranibizumab D. Combination therapy E. Any other alternatives Phil Rosenfeld : E-My motto when treating wet AMD, even RPE tears, is "Never Give Up, Never Surrender" (Galaxy Quest, 1999). I should never say never, since I might give up if there's profound vision loss from an advanced scar or extensive hemorrhage and the fellow eye still has good vision. Otherwise, I always try to preserve whatever vision I can, since I don't know what will happen to the fellow eye, and the eye that I'm treating may end up being the better seeing eye. RPE tears are part of normal disease progression and should be treated aggressively to eliminate macular fluid to maintain a dry macula. I'm not convinced that anti-VEGF therapy causes RPE tears, but rather, anti-VEGF therapy can prevent RPE tears, and we would see a lot more RPE tears if anti-VEGF therapy wasn't used. Furthermore, if anti-VEGF therapy causes RPE tears, why did the tear occur after the second injection? Based on when the tears occur, I'm just not convinced of a cause-andeffect relationship. So my answer is continue bevacizumab or ranibizumab or aflibercept so that scar formation is minimized and as much vision as possible can be preserved. Srinivas Sadda : C-I am comfortable continuing anti-VEGF therapy following an RPE rip as long as there are continued signs of exudation as in this patient. The only reason I would switch to ranibizumab in this case is because the patient was noted to have an increase in the serous detachment, and I would like to see if ranibizumab could produce greater drying in this patient. Dhananjay Shukla : A-Looking at the vision and the extent of rip on FFA, my first choice would be (A), but I would shift to (B) based on additional information. To recapture the situation, we have a legally blind (by Lighthouse International ...

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Section: How Would One Manage the Patient Furthermentioning

confidence: 91%

Anti-VEGF Therapy - Managing Challenging Case Scenarios

Anand¹

2014

Delhi Journal of Ophthalmology

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Vitrectomy does not Cure Bevacizumab Induced Uveitis

Cited by 1 publication

References 9 publications

Anti-VEGF Therapy - Managing Challenging Case Scenarios

Anti-VEGF Therapy - Managing Challenging Case Scenarios

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