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Rapid growth of primary uveal melanoma following intravitreal bevacizumab injection: a case report and review of the literature.
Ma, J, Roelofs, KA, Russell, L, Weis, E, Chen, SH
Digital journal of ophthalmology : DJO. 2021;(3):27-30
Abstract
Uveal melanoma size is a significant predictor of tumor metastasis. Although the relationship between antivascular endothelial growth factors (VEGF) and uveal melanoma growth has been studied, results are paradoxical, and the relationship remains controversial. We report the case of a 65-year-old man who presented with elevated intraocular pressure in his right eye, neovascularization of his iris, and significant corneal edema, which obscured the view of the angle. Given his history of proliferative diabetic retinopathy, he was diagnosed with neovascular glaucoma and subsequently received an intravitreal injection of bevacizumab and underwent Ahmed valve insertion. This was complicated by postoperative hyphema. Two and a half months postoperatively, a mass involving the inferior iris and ciliary body became visible, and fine-needle aspiration biopsy confirmed uveal melanoma. Seven weeks after diagnosis, the tumor's largest basal diameter had increased from 2.51 mm to 18.0 mm, and apical height increased from 6.23 mm to 11.0 mm. His right eye was enucleated. Histopathological analysis showed discontinuous invasion next to the Ahmed valve. Tumor progression after injection raises the possibility that in some untreated uveal melanomas, accelerated growth may occur following exposure to anti-VEGF agents.
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2.
RETINAL RACEMOSE HEMANGIOMA WITH FOCAL MACULAR INVOLVEMENT.
Barreira, AK, Nakashima, AF, Takahashi, VK, Marques, GA, Minelli, T, Santo, AM
Retinal cases & brief reports. 2016;(1):52-4
Abstract
PURPOSE To report a case of racemose hemangioma with macular involvement and treated with anti-vascular endothelial growth factor. METHODS Observational case report. RESULTS JFS, a 31-year-old woman, presented with a complaint of blurred vision in her right eye over the preceding 2 months, worsening during the previous month. An examination conducted in May 2013 showed visual acuity of 20/30 in her right eye and 20/20 in her left eye, deteriorating to 20/40 in the right eye 1 month later. Retinography of the right eye revealed a dilated tortuous retinal vessel in the lower temporal arcade, affecting the macular region. Because of progressive deterioration in the patient's visual acuity, she was treated with 3 intravitreal bevacizumab injections, with an interval of 1 month between them. At the end of the proposed treatment, the patient was followed up on an outpatient basis for 12 months, with visual acuity of 20/20 in both eyes and no signs of retinal exudation throughout the entire follow-up period. CONCLUSION Racemose hemangioma with focal macular involvement may lead to a progressive reduction in visual acuity because of exudation. Further studies need to be conducted to confirm the efficacy of bevacizumab injections to treat vascular malformation; however, this form of management does seem promising.
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3.
Intravitreal bevacizumab injection alone or combined with macular photocoagulation compared to macular photocoagulation as primary treatment of diabetic macular edema.
Javanović, S, Canadanović, V, Sabo, A, Grgić, Z, Mitrović, M, Rakić, D
Vojnosanitetski pregled. 2015;(10):876-82
Abstract
BACKGROUND/AIM: Within diabetic retinopathy (DR), diabetic macular edema DIE) is one of the leading causes of the loss of visual acuity. The aim of this study was to determine the efficacy of the intravitreal vascular endothelial growth factor (VEGF) inhibitor application alone or combined with macular focal/grid lasephotocoagulation compared with laser treatment alone. METHODS This prospective randomized clinical trial included 72 patients (120 treated eyes) with varying degrees of DR and DME. The DME treatment included intravitreal VEGF inhibitor bevacizumab (Avasting) application, with and without laser treatment. Bevacizumab (1.25 mg/0.05 mL) was administered intravitreally in 4-6-week intervals. Laser is applied 4-6 weeks after last dose of the drug as a part of combined treatment, or as the primary treatment. RESULTS The mean reduction in central macular thickness (CMT) for the eyes (n = 31) treated with bevacizumab alone was 162.23 .rm, for the eyes (n = 53) treated with combined treatment the mean reduction in CMT was 124.24 pm, both statistically significant at p < 0.001. Laser macular photocolagulation as a part of combined treatment (in 53 eyes) significantly contributed to the CMT reduction, based on the paired t-test results (366.28 vs. 323.0 pLm at p < 0.05). In our study, the mean visual acuity improvement of 0.161 logMAR was achieved in the group of eyes treated with bevacizumab alone, and 0.093 logMAR in the group with combined treatment, both statistically significant atp < 0.05. The effect of laser photocolagulation alone on visual acuity and'CMT was not statistically significant. CONCLUSION Treatment with bevacizumab alone or within combined treatment is more effective in treating DME than conventional macular laser treatment alone, both anatomically and functionally.
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From palliative to curative treatment - stage IV mucinous adenocarcinoma, successfully treated with metronomic capecitabine in combination with Bevacizumab and surgery- a case report.
Vernmark, K, Albertsson, M, Björnsson, B, Gasslander, T, Sandström, P, Sun, XF, Holmqvist, A
BMC cancer. 2015;:884
Abstract
BACKGROUND Mucinous adenocarcinoma (MAC) represents 6-19 % of all colorectal carcinoma. It is associated with poorer response to chemotherapy and chemoradiotherapy. CASE PRESENTATION A 27-year-old Swedish woman presented with stomach pain and weight loss, and was diagnosed with locally advanced MAC in the transverse colon as well as 3 liver metastases. Neoadjuvant treatment with fluorouracil, folinic acid and oxaliplatin (FLOX) failed due to several infections, pulmonary embolism and deteriorated performance status. The patient was therefore considered palliative. Palliative treatment with metronomic capecitabine 500 mg × 2 daily and bevacizumab every other week were initiated. After 4 months of treatment the tumors had regressed and the patient was able to undergo radical surgery, thereby changing the treatment intention from palliative to curative. No adjuvant chemotherapy was given. There were no signs of recurrence 9 months later. CONCLUSIONS The role of the combination of metronomic capecitabine and bevacizumab in patients with MAC merits further investigation.
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5.
Blessing for the bleeder: bevacizumab in hereditary hemorrhagic telangiectasia.
Epperla, N, Hocking, W
Clinical medicine & research. 2015;(1):32-5
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by uncontrolled multisystem angiogenesis with epistaxis, gastrointestinal bleeding, iron-deficiency anemia, and arteriovenous malformations, and is often associated with increased levels of vascular endothelial growth factor (VEGF). Bevacizumab, a VEGF inhibitor, reduces epistaxis, telangiectasias, and iron-deficiency anemia. We present the case of a woman with HHT and chronic gastrointestinal bleeding who required iron supplementation and multiple blood transfusions. Bevacizumab resulted in marked symptom improvement and transfusion-independence. Our report describes the dose schedule and calls for a randomized, controlled trial demonstrating the value of bevacizumab therapy.