Retina Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Retina. 2012 Jan;32(1):60-7. doi: 10.1097/IAE.0b013e31822092b7.
To report 10 cases of occult choroidal neovascularization (CNV) associated with choroidal nevus managed with intravitreal bevacizumab.
Interventional case series. Each nevus was examined and imaged with fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. Data were retrospectively analyzed to evaluate outcomes of treatment response and visual acuity.
Nine patients presented with CNV overlying a chronic choroidal nevus with a posterior margin within 1.5 mm of the foveola. In the 10th patient, the posterior margin of the nevus was located 10 mm from the foveola with extension of subretinal fluid into the macula. The CNV was subfoveolar in four cases, juxtafoveolar in two cases, and extrafoveolar in four cases. Initial visual acuity was 20/20 to 20/50 in 5, 20/60 to 20/100 in 2, and 20/200 or worse in 3 cases. Clinical features included subfoveolar fluid in nine, exudation in five, and hemorrhage in four cases. Intravitreal bevacizumab (1.25 mg/0.05 cc) was injected with regression of CNV in all 10 cases using 2 to 14 injections (median 3 injections). In 2 eyes, after therapeutic response to bevacizumab later consolidation with photodynamic therapy (juxtafoveolar CNV) (n = 1) or conventional laser (extrafoveolar CNV) (n = 1) was provided. In the remaining 8 eyes, after discontinuation of bevacizumab, there was no recurrence of CNV over mean 10.1 months. At overall mean follow-up of 22.5 months, final visual acuity decreased by 1 line in 4 cases and improved by mean of 3 lines (range, 1-8 lines) in 6 cases. There were no adverse effects from bevacizumab injections. All 10 choroidal nevi remained stable.
Intravitreal bevacizumab appears to be an effective treatment option for CNV secondary to choroidal nevus. In some cases, depending on the proximity of the CNV to the foveola, photodynamic therapy or conventional laser may be useful adjunctive therapy.
报告 10 例脉络膜黑色素瘤相关隐匿性脉络膜新生血管（CNV），这些病例采用玻璃体内注射贝伐单抗进行治疗。
介入性病例系列研究。对每个黑色素瘤均进行荧光素血管造影、B 型超声和光学相干断层扫描检查和评估。回顾性分析数据，以评估治疗反应和视力结局。
9 例患者表现为 CNV 位于慢性脉络膜黑色素瘤上方，其后缘距黄斑中心凹后缘 1.5mm 以内。在第 10 例患者中，黑色素瘤后缘距黄斑中心凹 10mm，伴有视网膜下液延伸至黄斑。10 例患者中，CNV 累及黄斑中心凹者 4 例，近黄斑中心凹者 2 例，远离黄斑中心凹者 4 例。初始视力为 20/20 至 20/50 的 5 例，20/60 至 20/100 的 2 例，20/200 或更差的 3 例。临床特征包括黄斑中心凹下积液 9 例，渗出 5 例，出血 4 例。10 例患者均采用玻璃体内注射贝伐单抗（1.25mg/0.05cc）治疗，2 至 14 次注射（中位数 3 次）后，CNV 均消退。2 例接受贝伐单抗治疗后，分别行光动力疗法（近黄斑中心凹 CNV）（n=1）或传统激光（远离黄斑中心凹 CNV）（n=1）巩固治疗。在其余 8 例患者中，停止贝伐单抗治疗后，平均 10.1 个月内无 CNV 复发。总的平均随访时间为 22.5 个月，最终视力下降 1 行的有 4 例，提高 3 行（范围 1-8 行）的有 6 例。贝伐单抗注射无不良反应。所有 10 个脉络膜黑色素瘤均保持稳定。
玻璃体内注射贝伐单抗似乎是脉络膜黑色素瘤相关 CNV 的有效治疗选择。在某些情况下，根据 CNV 与黄斑中心凹的距离，光动力疗法或传统激光可能是有用的辅助治疗方法。
