Intravitreal bevacizumab for treatment of nonarteritic anterior ischemic optic neuropathy - PowerPoint PPT Presentation

1 / 12
About This Presentation
Title:

Intravitreal bevacizumab for treatment of nonarteritic anterior ischemic optic neuropathy

Description:

Intravitreal bevacizumab for treatment of non-arteritic anterior ... Microvascular insufficiency of the optic disc (pathogenesis unclear) Previously tried... – PowerPoint PPT presentation

Number of Views:364
Avg rating:3.0/5.0
Slides: 13
Provided by: margo1
Category:

less

Transcript and Presenter's Notes

Title: Intravitreal bevacizumab for treatment of nonarteritic anterior ischemic optic neuropathy


1
Intravitreal bevacizumab for treatment of
non-arteritic anterior ischemic optic neuropathy
  • Harmeet S. Gill MD, Daniel Rootman MD, Edward
    Margolin MD, FRCSCUniversity of Toronto,
    Department of Ophthalmology and Vision Sciences

2
  • The speaker and coauthors declare having no
    financial interest in any of the products
    discussed in this presentation

2
3
Non-arteritic anterior ischemic optic neuropathy
(NAION)
  • A common cause of acute optic nerve-related
    vision loss
  • Diagnosis decreased visual acuity, RAPD, VF
    defect, optic disc edema
  • No specific therapy with proven efficacy

4
Pilot Study
  • Investigate the potential benefit of intravitreal
    bevacizumab (Avastin) as a treatment option for
    NAION
  • Design prospective, interventional cohort study
  • Approved by Health Canada and Research Ethics
    Board

5
Participants
  • Diagnosis of NAION and active nerve swelling at
    the time of injection
  • No requirement for visual acuity
  • Control group patients declining the injection

6
Methods
  • All consecutive patients diagnosed with NAION
    from May 2009
  • Exclusion currently treated with Avastin, other
    comorbid eye disorders
  • All patients detailed history and exam including
    HVF 24-2, exclusion of other diagnosis

7
Methods
  • Treatment group single intravitreal injection of
    bevacizumab (1.25mg/mL), seen PID1
  • Follow-up 1, 3, and 6 months with visual
    acuities (ETDRS) and HVF 24-2 at each visit

8
Background
  • NAION ischemic event with up-regulation of VEGF
    that leads to optic disc swelling
  • Microvascular insufficiency of the optic disc
    (pathogenesis unclear)

9
Previously tried
  • pentoxifylline, antiplatelet agents, hyperbaric
    oxygen, anticoagulants, vasodilator agents,
    corticosteroids, heparin-induced low-density
    lipoprotein/fibrinogen precipitation, levodopa,
    optic nerve decompression surgery

10
Recently
  • 2 case reports of intravitreal triamcinolone with
    rapid resolution of optic disc swelling
  • Presented at NANOS this year 30 consecutive
    cases treated with bevacizumab with improvement
    in visual acuity better than natural history. No
    visual field data and no controls.
  • Kaderli B, Avci R, Yucel A, et al. Intravitreal
    triamcinolone improves recovery of visual acuity
    in nonarteritic anterior ischemic optic
    neuropathy. J Neuro-Ophthalmol 200727164-168.Y
    aman A, Selver OB, Saatci AO, Soylev MF.
    Intravitreal triamcinolone acetonide injection
    for acute non-arteritic anterior ischaemic optic
    neuropathy. Clin Exp Optom 200891(6)561-564.
  • Kelman S, Elman M, Mandava N, Bennett J.
    Intravitreal Bevacizumab for Nonarteritic
    Anterior Ischemic Optic Neuropathy A Pilot
    Study. Proceeds from the meeting of NANOS, Lake
    Tahoe, NV, February 2009

11
Rationale
  • NAION -- acute ischemic insult
  • Ischemia induces VEGF release
  • VEGF is proinflammatory
  • An inflamed disc at risk causes axonal loss
  • Anti-VEGF therapy may improve visual outcome in
    NAION patients

12
Avastin for NAION
  • First Pilot Study (2 patients in control group)
  • Currently Uni-center
  • Invite other physicians and centers to
    participate
  • Thoughts?
Write a Comment
User Comments (0)
About PowerShow.com