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      Intravitreal bevacizumab (Avastin) in choroidal neovascular membrane in angioid streaks

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          Abstract

          Angioid streaks are crack-like dehiscences in the Bruch′s membrane, which predispose to the development of a choroidal neovascular membrane (CNVM) that carries a poor visual outcome. We report successful treatment in a 25-year-old woman with bilateral angioid streaks and subfoveal CNVM in the left eye who received two doses of intravitreal bevacizumab (1.25 mg) injections six weeks apart, resulting in rapid regression of the CNVM.

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          Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration.

          To report the short-term safety, biologic effect, and a possible mechanism of action of intravitreal bevacizumab in patients with neovascular age-related macular degeneration (AMD). Interventional, consecutive, retrospective case series. Eighty-one eyes of 79 patients with subfoveal neovascular AMD. Patients received intravitreal bevacizumab (1.25 mg) on a monthly basis until macular edema, subretinal fluid (SRF), and/or pigment epithelial detachment (PED) resolved. Ophthalmic evaluations included nonstandardized Snellen visual acuity (VA), complete ophthalmic examination, fluorescein angiography, and optical coherence tomography (OCT). Assessments of safety, changes in Snellen VA, OCT retinal thickness, and angiographic lesion characteristics were performed. No significant ocular or systemic side effects were observed. Most patients (55%) had a reduction of >10% of baseline retinal thickness at 1 week after the injection. At 4 weeks after injection, 30 of 81 eyes demonstrated complete resolution of retinal edema, SRF, and PEDs. Of the 51 eyes with 8 weeks' follow-up, 25 had complete resolution of retinal thickening, SRF, and PEDs. At 1, 4, 8,and 12 weeks, the mean retinal thickness of the central 1 mm was decreased by 61, 92, 89, and 67 mum, respectively (P<0.0001 for 1, 4, and 8 weeks and P<0.01 for 12 weeks). At 4 and 8 weeks, mean VA improved from 20/200 to 20/125 (P<0.0001). Median vision improved from 20/200 to 20/80(-) at 4 weeks and from 20/200 to 20/80 at 8 weeks. Short-term results suggest that intravitreal bevacizumab (1.25 mg) is well tolerated and associated with improvement in VA, decreased retinal thickness by OCT, and reduction in angiographic leakage in most patients, the majority of whom had previous treatment with photodynamic therapy and/or pegaptanib. Further evaluation of intravitreal bevacizumab for the treatment of choroidal neovascularization is warranted.
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            Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration.

            To investigate the efficacy and safety of intravitreal bevacizumab for managing choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). Prospective interventional case series. Seventeen eyes of 17 patients with subfoveal CNV due to AMD participated in this study at the American University of Beirut Ophthalmology Clinics. All patients had failed, refused, or were not eligible for photodynamic therapy. All eyes received a baseline eye examination, which included best-corrected visual acuity (BCVA), dilated fundus examination, ocular coherence tomography (OCT) imaging, and fluorescein angiography. An intravitreal injection of bevacizumab (2.5 mg/0.1 ml) was given at baseline and followed by two additional injections at four-week intervals. BCVA, OCT, and fluorescein angiography were repeated four weeks after each injection. Main outcome measures were improvement in BCVA and central retinal thickness (CRT). Mean baseline BCVA was 20/252 (median 20/200), and baseline CRT was 362 microm (median 350 microm). Improvement in VA and CRT occurred by the fourth week. At 12 weeks, mean BCVA was 20/76 (P < .001) and median BCVA was 20/50 (P < .001). Both mean and median CRT decreased to 211 microm (P < .001). Thirteen (76%) of 17 eyes had total resolution of subretinal fluid, and four eyes (24%) had BCVA better than 20/50. No systemic or ocular side effects were noted at any time. Eyes with CNV due to AMD treated with intravitreal bevacizumab had marked anatomic and visual improvement. Further studies are necessary to confirm the long-term efficacy and safety of this treatment.
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              Phase II multicenter trial of bevacizumab plus fluorouracil and leucovorin in patients with advanced refractory colorectal cancer: an NCI Treatment Referral Center Trial TRC-0301.

              To provide bevacizumab (BV) -based therapy to patients with advanced colorectal cancers (CRC) who had exhausted standard chemotherapy options, and to evaluate the response to BV combined with fluorouracil (FU) and leucovorin (LV) in this patient population. This was a multicenter, single-arm treatment trial conducted under the National Cancer Institute Treatment Referral Center network nationwide. Patients were treated with BV 5 mg/kg every 2 weeks combined with FU/LV; FU was administered by bolus or continuous infusion. Eligibility criteria included advanced CRC that had progressed after irinotecan- and oxaliplatin-based chemotherapy, Eastern Cooperative Oncology Group performance status 0 to 2, and absence of thromboembolism. The primary end point was objective response rate (RR) in the first 100 assessable patients. All patients received follow-up for toxicity and survival. Due to rapid accrual, a total of 350 patients were enrolled at 32 participating sites nationwide by October 2003. In the initially planned cohort of 100 assessable patients, the objective RR was 4% (95% CI, 1.1% to 9.9%) by investigators' assessment and 1% (95% CI, 0% to 5.5%) based on independent review; median progression-free survival was 3.5 months and median overall survival was 9.0 months. The safety profile was similar to prior BV trials in CRC. Grade 3 to 4 hemorrhage occurred in 5% of patients, including 3.8% with bleeding in the GI tract. Other adverse events such as hypertension, thrombosis, and bowel perforation were also observed at rates consistent with other studies. For patients with advanced CRC that had progressed after both irinotecan-based and oxaliplatin-based chemotherapy regimens, the combination of BV and FU/LV was associated with rare objective responses.
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                Author and article information

                Journal
                Indian J Ophthalmol
                Indian Journal of Ophthalmology
                Indian Journal of Ophthalmology
                Medknow Publications (India )
                0301-4738
                1998-3689
                Nov-Dec 2007
                : 55
                : 6
                : 457-458
                Affiliations
                Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
                Author notes
                Correspondence to Dr. Amod Gupta, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012, India. Email: eyepgi@ 123456sify.com
                Article
                IndianJOphthalmol_2007_55_6_457_36482
                2635985
                17951904
                6b494817-8e69-44d4-b6db-f62a11a3641c
                Copyright: © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 August 2006
                : 28 September 2006
                Categories
                Brief Report

                Ophthalmology & Optometry
                angioid streaks,subfoveal choroidal neovascular membrane ,intravitreal bevacizumab

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