Avastin for chronic central serous chorioretinopathy A study report that intravitreal Avastin (bevacizumab) is effective in decreasing central retinal thickness and improving visual acuity in patients with chronic central serous chorioretinopathy (CSCR).

CSCR is a disease of young and middle-aged adults that frequently manifests symptomatically in one eye, while up to 18% of cases may be bilateral. Research indicates that the disease process in CSCR is more diffuse and shows bilateral retinochoroidal dysfunction, even when the disease is manifesting clinically only in one eye. Though the cause of CSCR remains unknown, it is believed that abnormalities in choroidal circulation make overlying retinal pigment epithelium dysfunctional, resulting in the development of a serous retinal detachment. Photodynamic therapy, laser photocoagulation and pharmacological agents have been used to treat CSCR. However, these treatment options serve only to shorten the duration of symptoms and have no effect on the recurrence rate or the final visual acuity.

Twelve patients were treated with intravitreal injections of 2.5 mg Avastin at 6- to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses.

Patients received 2±1 intravitreal injections of bevacizumab on average during a follow-up of 24±14 weeks. Mean BCVA increased by 2±2 lines; the change in BCVA (logMAR) was significant (p<0.02). Mean central retinal thickness decreased significantly over follow-up (p<0.05), with 6 patients (50%) showing complete resolution of subretinal fluid.

The investigators conclude that anatomic and functional improvement following intravitreal Avastin injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSCR. This is consistent with previous research that found Avastin was effective in the treatment acute CSCR. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSCR. The researchers state that further evaluation of intravitreal Avastin for chronic CSCR in controlled randomized studies is warranted.

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Eur J Ophthalmol. 2009;19(4):613-7