Sir,
I read the article by Shah and Shah1 with great interest. I congratulate the authors for evaluating the effects of early single intravitreal injection of bevacizumab followed by panretinal and macular grid photocoagulation laser in central retinal vein occlusion (CRVO) with macular oedema.
I would like to share my experience of single early intravitreal injection of bevacizumab in two cases of macular oedema secondary to central retinal vein occlusion. Both patients had only a single intravitreal injection of bevacizumab within a week of onset of symptoms, without the need for panretinal photocoagulation or macular grid lasers.
Case reports
Case 1
A 23-year old male presented with left eye CRVO and macular oedema and a visual acuity (VA) of 6/24. He received a single intravitreal injection of Avastin at 6 days after the onset of symptoms. He was seen 11 days later with VA of 6/6 and OCT showing resolution of macular oedema. Seventeen months later, his left VA remains 6/4.8 (unaided) and no macular oedema on OCT. He did not need any further intervention after the first injection.
Case 2
A 79-year old male presented with left CRVO with macular oedema and a VA of 2/60. He had neovascular glaucoma in the other eye secondary to CRVO. When seen 3 days after the onset of his symptoms in the left eye, he underwent an intravitreal injection of Avastin the same day. VA returned to 6/9 in 2 weeks. Twenty one months later, he still maintains a VA of 6/9 unaided and has no macular oedema on OCT.
Comment
Both patients did not need any further injections after the first one, nor did they receive extensive retinal lasers as was the case in the article by Shah and Shah.1 I agree, larger studies are needed to substantiate the results, but until then it is best to treat on a case by case basis.
References
Shah NJ, Shah UN . Long-term effect of early intervention with single intravitreal injection of bevacizumab followed by panretinal and macular grid photocoagulation in central retinal vein occlusion with macular oedema: a Pilot study. Eye 2011; 25: 239–244.
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Patil, B. Bevacizumab (Avastin) in central retinal vein occlusion. Eye 25, 1516–1517 (2011). https://doi.org/10.1038/eye.2011.192
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DOI: https://doi.org/10.1038/eye.2011.192