Does Avastin Work for Retinal Vein Occlusions?

January 6, 2010

As reported in Ophthalmology, a small prospective study finds improvement in patients sustaining retinal vein occlusion (RVO) treated with Avastin.

This study followed 29 eyes injected with 3 consecutive injections of Avastin.  Each treatment was 4 weeks apart.  Visual acuity and macular thickness were followed using ETDRS and OCT.

There were improvements in all parameters.  The vision improved and was maintained to the end of the study at 12 months.  Retinal thickness, as measured with conventional and spectral domain OCT, improved similarly.

Randall V. Wong, M.D.
Retina Specialist Fairfax, Virginia

 

 

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32 Responses to “Does Avastin Work for Retinal Vein Occlusions?”

  1. Joseph Nantista on January 26th, 2010 11:18 am

    My doctor wants to use AVASTIN-{OFF-Label} to treat my Macular Pucker. Macular Pucker is present in both eyes. I’ve read what I can about its use with macular degeneration but nothing specific regarding Macular Pucker. Is there any study available ? Thank you.

  2. Randall V. Wong, M.D. on January 27th, 2010 8:45 am

    Not sure if I am aware of a study. Macular pucker can cause macular edema by physical disruption of the retinal surface. The macular edema caused would be secondary to this “traction.”

    In cases of macular pucker, unlike other cases of maculara edema, the retinal vessels are normal.

    R. Wong, M.D.

  3. John Scott on August 9th, 2010 7:48 pm

    I just had my first shot of avastin today for retinal vein occlusion. I’ll let you know how it works. It was a scary thought but no pain was involved, or very little. My eye has been watering a bit. The whole thing kind of freaked me out, but really was not too bad. I hope it helps as I have a blurry spot in my left eye. I have always taken my vision for granted.

  4. Annette on August 25th, 2010 9:35 pm

    If someone has a retinal vein occlusion, and tries Avastin, what are the possible complications?

    How many shots would be given?

    How quickly would someone notice improvement?

  5. ari weitzner on August 26th, 2010 7:33 pm

    complications are practically nil. should see improvement in about a month. you may need repeated injections over the next 6-12 months if the improvement starts to wane. if avastin fails, consider kenalog.

  6. Randall Wong, M.D. on August 27th, 2010 5:16 am

    I agree with Dr. Weitzner.

    The combination of drugs, such as Avastin, and streroids (Kenalog) seen to be a pretty good treatment regimen.

    An alternative, with/without, Avastin is an implant called Ozurdex. Ozurdex releases steroid for about 4-6 months and is indicated for RVO.

    All the best,

    Randy

  7. Annette Gomez on September 12th, 2010 10:44 am

    Thank you Dr.’s Weitzner and Dr. Wong (do either of you see patients either for a consult or for treatment)?

    My friend also has glaucoma, in addition to RVO. Would Avastin and possibly kenalog still be your suggested protocol?

    Looking for the best choice, for the best outcome, with the least complications.

    One other question, is Avastin treatment ‘special’ in the sense that it should be given by someone who is much more familiar with it, such as yourselves? or has it become ‘standard treatment’ now?

    Annette

  8. Richo on December 19th, 2010 5:10 am

    Got a branch retinal vein occlusion , been observed for 12 months with two bouts of laser done over that period . My vision is twisted and very poor in that eye . I have received a shot of avastin in that eye 5 days ago and clarity is better . Still twisted but am due to get another in 4 weeks … Fingers crossed as it’s been a hard 12 months …. Richo

  9. Randall Wong, M.D. on December 19th, 2010 12:30 pm

    Dear Richo,

    I wish you the best of luck. I continue to be amazed at how effectively, and completely, certain patients improve with Avastin for BRVO.

    Thanks for your comment!

    Randy

  10. anthony S on April 15th, 2011 12:56 am

    my left eye was getting harder to focus about 4yrs ago. my welding was getting poorer because i could not focus. I thought it was my prerscription on my glasses,not. I was driving one day and all of a sudden a black spot shows up and i have terrible time with depth perception. 5 days later i get Avastin into the eye. The Dr said it was a leaking blood vessel. they dont know what causes it. My sight was measured at 2070/20 and 20/20 on the right.eye. about a week later the bad eye was down to 270/20 and the sight and black spot got better. 4 wks later i got another shot and i went to another dr. for a second opinion . they said my Dr was doing the best and latest to help the eye. I went for the third injection. the spot has been clearing up but i wanted the inj. in 3 wks not 4. He agreed. tomorrow i get another. this has been going on for 3 months. I still have the spot but not as bad and seems to be getting clearer. reading seems to be improving but very slowly. ok, that’s it ……………..TS

  11. R Johnson on December 18th, 2011 2:17 pm

    I have been treated for approximately three three for BRVO with injections of Avastin every 5-6 weeks. The vision in my left eye is somewhere between 300-400/20. I do not see much improvement between the injections. I did under go surgery which was unsuccessful. I for a time also received injections using Kenilog. I developed a cataract in the left eye and had surgery. What happens if I stop having the injections?

  12. ari on December 19th, 2011 10:05 am

    if avastin/kenalog injections do not help you by now, most likely it never will. consider a second opinion from a retina specialist re: continuing with these injections. what surgery did you undergo?

  13. Bubbles on January 23rd, 2012 6:40 pm

    My husband had a retinal vein occlusion last autumn. He had an injection of avastin just before Christmas and his sight improved enormously. However, it’s now 7 weeks after the injection and his sight is just starting to go wrong again. How long can he go on having injections, and do they begin to have a lasting effect? He’s 62.

  14. ari on January 24th, 2012 10:02 am

    typically a patient will need several injections- monthly for the first 3 months, then as needed thereafter. he needs to go back to the ophthalmologist for an oct scan and likely repeat injection.

  15. Diane Allen on February 21st, 2012 12:33 pm

    I experienced a central vein occlusion/ left eye almost 1 year ago. I initially had 3 injections of Avastin, each 1 month apart. My Dr. then tried the steroid shot, but it only lasted 3 months instead of the 8 to 12 hoped for. I have just received my 4th shot in the latest series. These shots have been my only answer to maintaining my vision. My question is how long can I continue to get Avastin injections? I also had a branch retinal vein occlusion in my other eye 10 years ago for which there wasn’t a treatment for at that time. I have very limited useful vision in that eye. So as you see I very much need to maintain my vision in my left eye.

  16. Randall Wong, M.D. on February 22nd, 2012 12:21 pm

    Dear Diane,

    It has been my experience that we can easily give intravitreal injections, such as Avastin, on a monthly basis for at least several years.

    Have you had any experience with Ozurdex or other steroids?

    Randy

  17. ari on February 22nd, 2012 2:31 pm

    you can get many injections- the risk is very small. keep getting as many as the doctor suggests.

  18. DonnyB on March 15th, 2012 10:27 pm

    I have been having injections of Avastin since 2007 and have maintained very good eyesight for 5 years , injections have been varied from 6 – 10 weeks although in the last 12 months they have not been stretched out past 7 weeks…..went to the doc yesterday for the injection and he seems to think that my sight will no longer be maintained and will be reduced.

    My question is do I have any other options available as his advice was that for this condition Avastin is the best…………………

  19. ari on March 16th, 2012 8:43 am

    you may want to consider kenalog injection

  20. Andrea Sexton on April 3rd, 2012 10:25 am

    I hate being a newby but I am kind of freaked out right now. Yesterday, I was diagnosed with Cystoid Macular Edema (Eye Condition) primary and Branch Retinal Vein Occusion. I’m going to be 66 in a week and a half and I happen to have beautiful eyes (as I bet most of you do). My doc referred me to a group and she told me all about Avastin. Just how many studies have been done using it for eyes? Any long-term studies? I know I’ll find out when I go to the doctor, but I want to be prepared. Am I likely to have an Avastin shot the first visit. I’m trying not to panic–I’d like to understand what a conservative course of action might be for me.

  21. ari on April 4th, 2012 9:00 am

    avastin is very safe- thousands of injections have been done, and dozens of studies. it is no longer considered experimental/new, but rather standard of care. only mildly painful and quick. very effective. you may want to wait like 3 months to see if it clears on its own, but i would follow the ophthalmologist’s advice if he favors doing it now. if it were my eye, i would have it done immediately.
    dont sweat it, maam!

  22. Randall Wong, M.D. on April 4th, 2012 11:12 am

    Dear Andrea,

    There are 4 possible treatment options in patients with BRVO;

    1. Do nothing – you might be happy with your vision and don’t fell like anything needs to be done. Left untreated, the BRVO will probably NOT get worse.

    2. Laser treatment if there is swelling…and there usually “macular edema.” All treatments are aimed at minimizing the macular swelling. Laser treatment was the first standardized treatment for this condition starting in the early 1980′s. I often suggest this as the first line of therapy for my patients.

    3. Avastin injections are a great alternative if either the macular edema persists, or, is not treatable with laser. I agree with Ari on that point. I disagree that the injections hurt….they usually do not. Ask you doctor about thoughts after you meet him/her. Also, I doubt you’ll be given an injection that day.

    4. Injection of steroids, in particular Ozurdex, may also be an option and is highly effective in reducing macular edema.

    Best of luck. Keep us updated!

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia

  23. Susan Fry on April 10th, 2012 5:51 am

    Hi All, especially Andrea, I know how you feel. I had BRVO last july and thought I had dodged the Avastin bullet…until Dec and had 1 injection then (as my eye had developed oedema) – I don’t care what anyone else says…it hurts (slightly more than a bit!). Had a laser done next month – really weird sensation! No improvement from either treatment. Back to the injections now for the next few months to give the drug a decent shot at helping. I have 20/20 vision, even in that eye, just everything is blurry and distorted above the centre. I actually lost the central vision about 2 weeks ago. Within 3 days of the injection last week, I can already ‘see’ an improvement. Fingers are crossed. I’ve already forgotten the hurt and am ‘looking’ forward to having the next injection so I can take the best possible care of my eyesight. I figure everyone has some health issue they need to deal with that isn’t fun so this is our lot. Just take a deep breath, trust your retinal specialist and take special care of your general health. Good luck and I wish you all best vision.

  24. Joan Emmrich on July 7th, 2012 11:11 am

    I have received 5 injections of Avastin for retinal vein occlusion. My films did show a slight improvement but the last several show my edema is status quo. My vision has not improved much at all. I do not have pain with the injection, but severe pain and watering in the eye about 4 hours after the injection. This pain will last for about 4-5 hours. Am I allergic to the Avastin or what?

  25. Noelle Silk on July 9th, 2012 3:27 pm

    Back to the question of Avastin injections for macular pucker/epiretinal membrane. Just trying to be a wise consumer of medical services. Mom’s retina specialist is recommending it for her right eye. She previously had the injections for wet AMD in the left eye. From my understanding of how Avastin works, I don’t see how it would affect the pucker, and I have found no info on its use for this condition. The injections DO hurt, I’d rather not subject her to the trauma if Avastin is not really effective against macular pucker. So, should she take the Avastin injections now?

  26. Randall Wong, M.D. on July 12th, 2012 10:03 am

    Noelle,

    Your mom’s doctor might be trying to improve any swelling/macular edema secondary to the membrane, but in my opinion, the problem is the macular pucker.

    …that’s why you can’t/won’t find anything to read about Avastin and macular pucker.

    Regarding the injections – they usually don’t hurt. I have found a subset of my patients are very intolerant to the iodine prep used to clean the eye. It can cause a ton of pain lasting about 24 hours and develops right after the injection. Many patients therefore mistakenly feel the actual injection is painful, but it may indeed be the iodine.

    I don’t know if this is exactly the case with your mom and I’m just making a suggestion.

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia

  27. Janel on December 22nd, 2012 7:43 am

    I was diagnosed with proliferative retinopathy several days ago after an angiogram on both eyes. On that same day, I received a shot of avastin in my worst eye. In a couple of weeks i will receive a laser treatment in the worst eye.

    I have read on this board that it can take several months for the avastin to work. Will I need to do this for the rest of my life? I am only 35 years old. Blood Vessels are leaking in both eyes, but vision is distorted in only one eye so far.

    The doctor does not spend much time with me and gives me vague and short answers. Do any of you know what my long term prognosis looks like? Thanks so much.

  28. Randall Wong, M.D. on December 27th, 2012 9:14 am

    Dear Janel,

    Avastin may be effective in treating both the neovasularization seen in proliferative diabetic retinopathy and the leaking blood vessels in macular edema.

    Laser, too, is used in both cases.

    Neither is a cure for either the macular edema or proliferative diabetic retinopathy.

    Both must be monitored lifelong.

    Lastly, in my experience, Avastin when used for PDR works quickly and must be repeated. In the long run, the better treatment is achieved with PRP (panretinal photocoagulation) or laser treatment for PDR.

    Avastin, when used for macular edema, may take months to achieve results and is often used instead of or in addition to laser treatment (aka “focal laser”) for macular edema.

    Randall V. Wong, M.D.
    Ophthalmologist, Retina Specialist
    Fairfax, Virginia

  29. Tyler Long on May 1st, 2013 7:22 am

    That’s really great that in this survey there were only improvements no harm to the patients.People think that Avastin is a unreliable product. Your post really helped me in understanding the actual result of Avastin. http://compoundingrxusa.com/general-compounding/

  30. Dr Helena K. on August 9th, 2013 5:21 am

    Please, tell me when it is the best time to start with Avastin for macular edema after BRVO? Is it better to wait a little (some article suggesting about 3 months because the possibility to form the collaterales) or we can start immediatelly with Avastin to prevent chronic macular edema?
    Thank you

  31. ari on August 21st, 2013 11:29 am

    good q. no one really knows. its true that the edema can resolve on its own, so i would wait 3 months to see, but getting avastin immediately is not a bad idea, either, since its so safe.

  32. Francis Pasquini on February 16th, 2014 4:52 am

    Hello, All: I am 69 and developed BRVO in right eye last Oct 2013. Gray splotch appeared to the left of my line of vision. VA has remained 20/20 since the splotch does not block my direct vision. After much agonizing over the possible side effects, I agreed to have the Avastin injection in Oct. No pain and no lasting side effects. I have had 4 injections through Jan 2014. Went to the RS last week, 02/14/14, macular edema has gone down quite a bit; i asked the RS if that damned splotch will ever disappear; she suggested Kenalog but I expressed concern at the risk of cataract formation; she said that one time at a low dose would not cause a cataract; only prolonged injections might possibly lead to cataract. So we agreed to another Avastin next week. After that, we will see if the swelling and splotch completely disappear, and if not, whether I will be willing to risk the Kenalog. I have pretty much ruled out laser due to fear of blind spot formation. God Bless everyone on this site and best of health for your eyes!!

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