Therapeutic Efficacy of Intravitreal Bevacizumab (Avastin)® in Patients with Parafoveal Telangiectasia Type II Complicated by Choroidal Neovascular Membrane and/or Cystoid Macular Edema

Abstract

Aim: To evaluate the therapeutic efficacy of intravitreal bevacizumab (Avastin)® on visual acuity and macular edema in patients with parafoveal telangiectasia type II complicated by choroidal neovascular membrane and/or cystoid macular edema. Methods: Study conducted over a period of 12 months, at a tertiary eye care hospital including forty eyes of 25 patients (11 male, 14 female) suffering from type II parafoveal telangiectasia with choroidal neovascular membrane and/or cystoid macular edema who fulfilled the inclusion criteria. These were treated with intravitreal bevacizumab (Avastin). Each of the 40 eyes was enrolled into one of two groups, namely group 1: Eyes with parafoveal telangiectasia type II with choroidal neovascular membrane and group 2: Eyes with parafoveal telangiectasia type II with presence of cystoid macular edema but without choroidal neovascular membrane .All the patients underwent best corrected visual acuity slit lamp bimicroscopy, direct and indirect ophthalmoscopy, intra ocular pressure (IOP), clinical fundus photography, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). Follow up of patients was done at the first, third and sixth months after presentation. Results: 2 groups, in group1-11 patients with equal male and female ratio, mean age 56.27±8.49 years, group 2-18 patients with female preponderance, mean age 53.5±7.18 years. In group1, no significant improvement in mean BCVA before inj. Bevacizumab 0.121±0.06 and after injection 0.147±0.06 (p=0.051), while statistically significant improvement noticed in mean CFT, before inj. 469±89.67 and after injection 310.78±85.61 (p=0.001). Similarly in group 2, no significant improvement in mean BCVA before inj. Bevacizumab 0.224±0.16 and after injection 0.254±0.09 (p=0.453), while statistically significant improvement noticed in mean CFT, before inj. 356.77±43.22 and after injection 253±42.59 (p=0.001). Transient hyperemia and subconjunctival hemorrhage were noticed in 2 patients in both group 1 and 2, while increase in blood pressure were observed in 2 patients in group 1 and 4 in group 2. None of the patients reported deterioration of vision following the injection. Conclusion: In parafoveal telangiectasis type II complicated by choroidal neovascular membrane there is definite short-term improvement in the visual acuity (approaching statistical significance) and definite significant reduction of central foveal thickness following intravitreal injection of bevacizumab. In patients suffering from parafoveal telangiectasis type II complicated by cystoid macular oedema, there is definite significant reduction of central foveal thickness but no significant improvement in the visual acuity following intravitreal injection of bevacizumab. Bevacizumab is safe and well tolerated in eyes with parafoveal telangiectasis type II complicated by choroidal neovascular membrane and/or cystoid macular edema. No severe ocular or systemic adverse effects were encountered in this study.