This was an Internal Review Board-approved retrospective review of 27 eyes of 27 patients with choroidal
nevus treated for secondary vascular activity with
intravitreal injections of
bevacizumab, performed by a single surgeon (TGM) at the Bascom Palmer Eye Institute. All patients were rigorously evaluated before the procedure and followed thereafter with ophthalmic examinations, refractive analysis, fundus photos, optical coherence tomography (OCT), and ocular echography. Patient demographics,
tumor characteristics, dates of
bevacizumab injections, and spectral-domain (SD)-OCT findings at each injection were recorded.
Macular edema was graded as per SD-OCT findings for the initial and final visit.
RESULTS: The mean age was 66.6 years (range, 40-86 years), with ten males and 17 females. Mean, median, and range baseline best corrected visual acuity (BCVA) were 20/53, 20/40, and 20/20-4/200, respectively. After a mean follow up of 29 months, the final BCVA mean, median, and range were 20/50, 20/40, and 20/20-20/400, respectively. The final BCVA ranged from 20/20 to 20/25 in nine eyes, while only six eyes had an initial BCVA within the same range. All patients demonstrated OCT findings of vascular activity suggestive of
choroidal neovascularization (CNV). Initial SD-OCT findings included intraretinal
cysts in eleven eyes, intraretinal fluid in six eyes, subretinal fluid in 14 eyes, pigment epithelial detachment in six eyes,
epiretinal membrane in five eyes, and subretinal neovascularization in 14 eyes. On fundus photos, four eyes presented
retinal hemorrhage. A mean of eight (range of 1-31) intravitreal
bevacizumab (1.25 mg/0.05 cc)
injections were given in all cases. A total of 37% (10/27) of eyes had complete or partial regression of vascular activity. The mean initial OCT classification for
macular edema was 3 and a mean grade of 3 was maintained at the final follow-up OCT. All 27 choroidal
nevi remained stable, and there were no adverse effects from the
bevacizumab injections.
CONCLUSION: To our knowledge, this is the largest published case series of eyes treated with intravitreal
bevacizumab for vascular activity associated with choroidal
nevus. Intravitreal
bevacizumab seems to be effective in the treatment of CNV secondary to choroidal
nevus, and OCT can be a useful tool in the follow up of these patients, to assess the regression of CNV and to monitor
macular edema.