Journal List > J Korean Ophthalmol Soc > v.55(3) > 1009911

Kweon: Factors Influencing the Effect of the Intravitreal Bevacizumab Injection in Patients with Central Serous Chorioretinopathy

Abstract

Purpose

To evaluate the factors influencing the effect of the intravitreal bevacizumab injection in patients with central serous chorioretinopathy.

Methods

We performed a retrospective review of the medical records of 54 patients (56 eyes) who had been symptomatic for more than 3 months with central serous chorioretinopathy (CSC), who had undergone intravitreal bevacizumab injection and been on regular follow-up for at least 6 months.

Results

Responders were 34 eyes (60.7%) and non-responders were 22 eyes (39.3%). The leaking points of the non-res-ponder group were multiple and located more centrally than that of the responder group on fluorescein angiography (FA) (p = 0.01, p = 0.044). In addition, non-responder group showed cystoid macular edema on optical coherence tomography (OCT) as compared with responder group (p = 0.042).

Conclusions

CSC with multiple, centrally located leaks on FA or cystoid macular edema on OCT was ineffective or recurrent with intravitreal bevacizumab injection.

References

1. Gass JD. Pathogenesis of disciform detachment of the neuroepithelium. ∏. Idiopathic central serous chorioretinopathy. Am J Ophthalmol. 1967; 63:587–615.
2. Yannuzzi LA, Gitter KA, Schatz H. The macula: a comprehensive text and atlas. 2nd ed.Baltimore: William & Wilkins;1982. p. 145–65.
3. Gilbert CM, Owens SL, Smith PD, Fine SL. Long-term follow-up of central serous chorioretinopathy. Br J Ophthalmol. 1984; 68:815–20.
crossref
4. Wang MS, Sander B, Larsen M. Retinal atrophy in idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2002; 133:787–93.
5. Iida T, Yannuzzi LA, Spaide RF, et al. Cystoid macular degeneration in chronic central serous chorioretinopathy. Retina. 2003; 23:1–7. quiz 137-8.
crossref
6. Burumcek E, Mudun A, Karacorlu S, Arslan MO. Laser photocoagulation for persistent central serous retinopathy: results of long-term follow-up. Ophthalmology. 1997; 104:616–22.
7. Battaglia Parodi M, Da Pozzo S, Ravalico G. Photodynamic therapy in chronic central serous chorioretinopathy. Retina. 2003; 23:235–7.
crossref
8. Cardillo Piccolino F, Eandi CM, Ventre L, et al. Photodynamic therapy for chronic central serous chorioretinopathy. Retina. 2003; 23:752–63.
crossref
9. Chan WM1, Lam DS, Lai TY, et al. Choroidal vascular remodel-ling in central serous chorioretinopathy after indocyanine green guided photodynamic therapy with verteporfin: a novel treatment at the primary disease level. Br J Ophthalmol. 2003; 87:1453–8.
crossref
10. Yannuzzi LA, Slakter JS, Gross NE, et al. Indocyanine green an-giography-guided photodynamic therapy for treatment of chronic central serous chorioretinopathy: a pilot study. Retina. 2003; 23:288–98.
11. Canakis C, Livir-Rallatos C, Panayiotis Z, et al. Ocular photodynamic therapy for serous macular detachment in the diffuse retinal pigment epitheliopathy variant of idiopathic central serous chorioretinopathy. Am J Ophthalmol. 2003; 136:750–2.
crossref
12. Taban M, Boyer DS, Thomas EL, Taban M. Chronic central serous chorioretinopathy: photodynamic therapy. Am J Ophthalmol. 2004; 137:1073–80.
crossref
13. Chung SE, Kang JH, Kang SW. Chronic central serous chorioretinopathy: photodynamic therapy. J Korean Ophthalmol Soc. 2007; 48:279–84.
14. Chang MH, Kim SW, Oh JR, Huh K. Photodynamic therapy with verteporfin using half fluence for chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2009; 50:1326–33.
crossref
15. Kim M, Chung H. The result of photodynamic therapy in chronic central serous chorioretinopathy. J Korean Ophthalmol Soc. 2009; 50:1035–43.
crossref
16. Torres-Soriano ME, García-Aguirre G, Kon-Jara V, et al. A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports). Graefes Arch Clin Exp Ophthalmol. 2008; 246:1235–9.
crossref
17. Huang WC, Chen WL, Tsai YY, et al. Intravitreal bevacizumab for treatment of chronic central serous chorioretinopathy. Eye (Lond). 2009; 23:488–9.
crossref
18. Seong HK, Bae JH, Kim ES, et al. Intravitreal bevacizumab to treat acute central serous chorioretinopathy: short-term effect. Ophthalmologica. 2009; 223:343–7.
crossref
19. Kim HS, Lee JH. The short-term effect of intravitreal bevacizumab for treatment of central serous chorioretinopathy. J Korean Ophthalmol Soc. 2010; 51:860–4.
crossref
20. Costa RA, Scapucin L, Moraes NS, et al. Indocyanine green-medi-ated photothrombosis as a new technique of treatment for persistent central serous chorioretinopathy. Curr Eye Res. 2002; 25:287–97.
crossref
21. Costa RA, Farah ME, Freymüller E, et al. Choriocapillaris photodynamic therapy using indocyanine green. Am J Ophthalmol. 2001; 132:557–65.
crossref
22. Guyer DR, Yannuzzi LA, Slakter JS, et al. Digital indocyanine green videoangiography of central serous chorioretinopathy. Arch Ophthalmol. 1994; 112:1057–62.
crossref
23. Prünte C, Flammer J. Choroidal capillary and venous congestion in central serous chorioretinopathy. Am J Ophthalmol. 1996; 121:26–34.
24. Spaide RF, Hall L, Haas A, et al. Indocyanine green videoangiography of older patients with central serous chorioretinopathy. Retina. 1996; 16:203–13.
crossref
25. Lai TY1, Chan WM, Lam DS. Transient reduction in retinal function revealed by multifocal electroretinogram after photodynamic therapy. Am J Ophthalmol. 2004; 137:826–33.
crossref
26. Tzekov R, Lin T, Zhang KM, et al. Ocular changes after photodynamic therapy. Invest Ophthalmol Vis Sci. 2006; 47:377–85.
crossref
27. Lee JY, Chae JB, Yang SJ, et al. Intravitreal bevacizumab versus the conventional protocol of photodynamic therapy for treatment of chronic central serous chorioretinopathy. Acta Ophthalmol. 2011; 89:e293–4.
crossref
28. Semeraro F, Romano MR, Danzi P, et al. Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy. Jpn J Ophthalmol. 2012; 56:608–12.
crossref
29. Lim JW, Kim MU, Shin MC. Aqueous humor and plasma levels of vascular endothelial growth factor and interleukin-8 in patients with central serous chorioretinopathy. Retina. 2010; 30:1465–71.
crossref

Table 1.
Characteristics of responders (group 1) and non-responders (group 2)
  Group 1 Group 2 p‐ value
No. of patients (M:F) 32 (27:5) 22 (21:1) 0.383*
Age 49.12 ± 7.00 48.40 ± 7.52 0.720
BCVA at first visit (log MAR) 0.308 ± 0.325 0.326 ± 0.384 0.963
Number of injection 1.18 ± 0.39 2.86 ± 0.83 <0.001

Values are presented as mean ± SD. BCVA = best corrected visual acuity.

* Fisher’s exact test

Wilcoxon rank sum test.

Table 2.
Fluorescein angiographic characteristics of patients in group 1 and group 2
Angiographic findings Group 1 Group 2 p‐ value*
Mean number of leaking point 1.26 ± 0.35 1.90 ± 0.42 0.010
Smokestack type leaking pattern 8 2 0.142

Values are presented as mean ± SD.

* Pearson’s t-test.

Table 3.
Treatment response of patients in zone I and zone II
  Zone Ⅰ Zone Ⅱ p‐ value*
Group 1 27 7 0.044
Group 2 20 2  

* Chi-square test.

Table 4.
Preoperative OCT characteristics of patients in group 1 and group 2
OCT findings Group 1 Group 2 p-value*
CMT (μm) 385.4 ± 102.14 352.2 ± 98.35 0.336
RPE detachment 8 4 0.641
Bulging of RPE 9 6 0.948
Cystoid degeneration 0 4 0.042
Discontinuity of IS/OS 4 1 0.364

Values are presented as mean ± SD.

OCT = optical coherence tomography; CMT = central macular thickness; RPE = retinal pigment epithelium; IS/OS = inner segment/outer segment.

* Pearson’s t-test.

TOOLS
Similar articles