title: Prophylactic use of bevacizumab to avoid anterior segment neovascularization following proton therapy for uveal melanoma.
abstract: OBJECTIVE
  To investigate whether the prophylactic use of bevacizumab reduces the rate of rubeosis after proton therapy for uveal melanoma and improves the possibility to treat ischemic, reapplicated retina with laser photocoagulation.
  
  
  METHODS
  Comparative retrospective case series.
  
  
  METHODS
  Uveal melanoma patients with ischemic retinal detachment and treated with proton therapy were included in this institutional study. Twenty-four eyes received prophylactic intravitreal bevacizumab injections and were compared with a control group of 44 eyes without bevacizumab treatment. Bevacizumab injections were performed at the time of tantalum clip insertion and were repeated every 2 months during 6 months, and every 3 months thereafter. Ultra-widefield angiography allowed determination of the extent of retinal ischemia, which was treated with laser photocoagulation after retinal reapplication. Main outcome measures were the time to rubeosis, the time to retinal reattachment, and the time to laser photocoagulation of ischemic retina.
  
  
  RESULTS
  Baseline characteristics were balanced between the groups, except for thicker tumors and larger retinal detachments in the bevacizumab group, potentially to the disadvantage of the study group. Nevertheless, bevacizumab prophylaxis significantly reduced the rate of iris rubeosis from 36% to 4% (log-rank test P = .02) and tended to shorten the time to retinal reapplication until laser photocoagulation of the nonperfusion areas could be performed.
  
  
  CONCLUSIONS
  Prophylactic intravitreal bevacizumab in patients treated with proton therapy for uveal melanoma with ischemic retinal detachment prevented anterior segment neovascularization, until laser photocoagulation to the reapplied retina could be performed.
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland. Electronic address: irmela.mantel@fa2.ch.
authors.forename: Irmela
authors.initials: I
authors.lastname: Mantel
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
authors.forename: Ann
authors.initials: A
authors.lastname: Schalenbourg
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
authors.forename: Ciara
authors.initials: C
authors.lastname: Bergin
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Petrovic
authors.affiliation: Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; University of Bern, Bern, Switzerland.
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
authors.affiliation: Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Zografos
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D015355:Glaucoma, Neovascular / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D007208:Indocyanine Green; D058449:Intravitreal Injections; D007498:Iris / Q000098:blood supply*; D017075:Laser Coagulation; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D061766:Proton Therapy; D011859:Radiography; D012189:Retrospective Studies; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D055815:Young Adult; D000098943:Uveal Melanoma
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004396:Coloring Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D007208:Indocyanine Green