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Intravitreal bevacizumab for iris neovascularization following proton beam irradiation for choroidal melanoma

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      Abstract

      Objective: To evaluate the safety and efficacy of intravitreal injections of bevacizumab as an eye-sparing treatment for iris neovascularization (NVI) following proton beam irradiation for choroidal melanoma.
      Design: Retrospective interventional case series.
      Participants: Four patients who received intravitreal bevacizumab for NVI following proton beam irradiation for choroidal melanoma were identified in the Department of Ophthalmology archives at the University of British Columbia. Methods: Clinical details were reviewed. Long-term follow-up of more than 2 years was detailed for each case.
      Results: All 4 patients responded to a single injection of bevacizumab with regression of NVI. Neovascular glaucoma (NVG) was evident in 3 cases, 2 of which had stable intraocular pressure following treatment. NVI recurred following a single injection in all patients after an interval ranging from 1 month to 12 months. A longer period of regression was seen in patients with fewer systemic neovascular risk factors and earlier treatment.
      Conclusions: Regression of NVI following proton beam irradiation for choroidal melanoma was seen in all treated patients. Repeated treatments may be required to maintain regression of new vessels. This treatment modality may be a useful eye-sparing adjunct in the prevention and treatment of NVG following proton beam irradiation.

      Résumé

      Objet: Évaluation de la sécurité et de l’efficacité des injections intravitréennes de bévacizumab comme traitement de protection oculaire lors de la néovascularisation de l’iris (NVI) àa la suite de l’irradiation par faisceau de protons pour le melanome de la choroïde.
      Nature: Rétrospective d’une série de cas d’intervention.
      Participants: Quatre patients qui ont reçu du bévacizumab dans le vitré pour la NVI à la suite d’une irradiation par faisceau de protons pour un mélanome de la choroïde, relevés dans les archives du Département d’ophtalmologie de l’Université de la Colombie-Britannique.
      Méthodes: Examen des rapports cliniques. Suivi detaillé à long terme de plus de 2 ans pour chaque cas.
      Résultats: Les 4 patients ont tous réagi à une seule injection de bévacizumab par une régression de la NVI. Le glaucome néovasculaire (GNV) était évident dans 3 cas, parmi lesquels 2 ont vu se stabiliser leur pression intraoculaire à la suite du traitement. Il y a eu récidive de NVI chez tous les patients après un intervalle de 1 à 12 mois. On a noté une plus longue période de régression chez les patients qui avaient moins de facteurs de risque généraux de maladie néovasculaire et reçu un traitement précoce.
      Conclusions: La réegression de la NVI à la suite d’une irradiation par faisceau de protons pour le mélanome de la choroïde a été observé chez tous les patients traités. La reprise du traitement pourrait être nécessaire pour maintenir la régression de nouveaux vaisseaux. Cette modalité de traitement peut ajouter une protection oculaire dans la prévention et le traitement de la GNV après l'irradiation par faisceau de protons.

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