title: Treatment of vascular activity secondary to atypical choroidal nevus using intravitreal bevacizumab.
abstract: OBJECTIVE
  To report the optical coherence tomography (OCT) findings of 27 eyes treated with intravitreal bevacizumab for intraretinal and subretinal vascular activity associated with atypical choroidal nevi.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Milena L
authors.initials: ML
authors.lastname: Cavalcante
authors.affiliation: Murray Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Villegas
authors.affiliation: Murray Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Gold
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Ludimila L
authors.initials: LL
authors.lastname: Cavalcante
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Marcela
authors.initials: M
authors.lastname: Lonngi
authors.affiliation: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Nisha V
authors.initials: NV
authors.lastname: Shah
authors.affiliation: Murray Ocular Oncology and Retina, Miami, FL, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
keywords: choroidal neovascularization; macular edema; optical coherence tomography; subretinal fluid
references.citation: Arch Ophthalmol. 2007 Nov;125(11):1501-7
references.pmid: 17998511
references.citation: Retina. 2005 Jun;25(4):438-42
references.pmid: 15933589
references.citation: Br J Ophthalmol. 2004 Jan;88(1):120-4
references.pmid: 14693788
references.citation: Br J Ophthalmol. 1977 Jun;61(6):414-6
references.pmid: 559514
references.citation: Ophthalmology. 2008 Mar;115(3):546-552.e2
references.pmid: 18067966
references.citation: Eur J Ophthalmol. 2004 Mar-Apr;14(2):123-31
references.pmid: 15134109
references.citation: Middle East Afr J Ophthalmol. 2010 Jul;17(3):201-6
references.pmid: 20844674
references.citation: Ophthalmology. 2012 May;119(5):1066-72
references.pmid: 22297027
references.citation: Eye (Lond). 2007 Dec;21(12):1531-3
references.pmid: 17024217
references.citation: Clin Ophthalmol. 2010 May 25;4:519-24
references.pmid: 20535228
references.citation: Arch Ophthalmol. 1993 Jun;111(6):789-94
references.pmid: 7685589
references.citation: J Ophthalmol. 2012;2012:385058
references.pmid: 23008756
references.citation: Retina. 2012 Jan;32(1):60-7
references.pmid: 21886019
references.citation: Ophthalmology. 2011 Feb;118(2):382-8
references.pmid: 20801518
references.citation: Am J Ophthalmol. 2003 Sep;136(3):575-6
references.pmid: 12967828
references.citation: Am J Ophthalmol. 2004 Dec;138(6):1074-5
references.pmid: 15629316
references.citation: Am J Ophthalmol. 2004 Jan;137(1):90-5
references.pmid: 14700649
references.citation: Curr Opin Ophthalmol. 2010 May;21(3):233-8
references.pmid: 20393294
references.citation: Retina. 2005 Apr-May;25(3):243-52
references.pmid: 15805899
references.citation: Arch Ophthalmol. 1997 Dec;115(12):1537-44
references.pmid: 9400787
references.citation: US Statut Large. 1996 Aug 21;110:1936-2103
references.pmid: 16477734
references.citation: Arch Ophthalmol. 2008 Jul;126(7):941-5
references.pmid: 18625940
references.citation: Ophthalmic Surg Lasers Imaging. 2005 Jul-Aug;36(4):343-5
references.pmid: 16156155
references.citation: Retina. 2012 May;32(5):936-41
references.pmid: 22366902
references.citation: Retina. 2006 Apr;26(4):477-9
references.pmid: 16603973