Intravitreal bevacizumab for treatment of peripapillary subretinal neovascularization

To describe the effects of intravitreal bevacizumab treatment for peripapillary subretinal neovascularization.

A patient with an idiopathic peripapillary subretinal neovascular membrane in the papillomacular bundle, which led to subretinal hard exudate deposits in the fovea and decreased visual acuity, was treated with a single intravitreal injection of 0.04 mL (1 mg) of bevacizumab. Main outcomes consisted of visual acuity, fluorescein (FA) and indocyanine green (ICG) angiography, and optical coherence tomography (OCT).

One week after the treatment the patient had less blurred vision and metamorphopsia but visual acuity was unchanged. At the 1 month visit the visual acuity improved and reduced leakage of the membrane was shown by FA and ICG. OCT demonstrated a reduction of the macular edema. At 14 months follow-up visit the membrane was not detectable with FA and ICG and only isolated remnants of the exudates were still present. OCT showed resolution of the macular edema and a residual hard exudate localized nasally to the fovea.

Treatment of peripapillary subretinal neovascular membrane with a single intravitreal injection of bevacizumab was effective and well-tolerated without recurrence of the neovascularization after a 14-month period. Visual acuity improved and retinal edema and exudation disappeared. The authors did not observe ocular or systemic side effects. In this view intravitreal injection of bevacizumab should be evaluated as a potentially effective therapy for peripapillary subretinal neovascularization, in particular for its extension in the papillomacular bundle.