Sir,

Vasoproliferative retinal tumours (VPRT) may cause retinal exudates, haemorrhages or detachment, macular oedema and epiretinal membranes.1, 2 Treatment modalities include perforating diathermy, photocoagulation, cryotherapy, brachytherapy,1 photodynamic therapy,2 and vitrectomy for tractional detachment or macular pucker.1

Since Bevacizumab (Avastin) was approved by the American Food and Drug Administration (FDA) in February 2004 for treatment of metastatic colorectal cancer,3 it has been used to treat various neovascular ocular pathologies, macular oedema, and bleb needling following trabeculectomy.

We report a patient with VPRT, who showed visual and clinical improvement after intravitreal Avastin.

Case report

A 59-year-old lady was referred in April 2006 with a right VPRT. She had been treated elsewhere with laser photocoagulation. Her general health was good apart from systemic hypertension. Examination showed right visual acuity of 6/6−1, and infero-temporal, pre-equatorial VPRT surrounded by hard exudates and old vitreous haemorrhage inferiorly (Figure 1). On ultrasonography, this tumour measured 5.0 mm in diameter and 1.7-mm thick (Figure 2). The patient was treated with triple freeze-thaw cryotherapy. In June 2006, the visual acuity worsened to 6/19 due to cystoid macular oedema (Figure 3a), and the tumour thickness increased to 2.6 mm. A decision was made to treat the patient with intraocular Avastin, 2.5 mg in 0.1 ml was administered in September 2006. Immediately after, the patient reported loss of sensation and weakness of her left arm and leg and was investigated for cerebrovascular accident, which was excluded. Five days later, the vision in the right eye had improved to 6/9+3 and the macular oedema was no longer visible. Twenty-four days after treatment, the visual acuity was 6/6−1, tumour thickness was 1.0 mm and the macular oedema was no longer demonstrable on OCT (Figure 3b).

Figure 1
figure 1

Colour fundus photograph of right infratemporal region showing vasoproliferative retinal tumor with hard exudates and vitreous haemorrhage.

Full size image
Figure 2
figure 2

RE VPRT on B scan ultrasonography showing tumour diameter of 5.0 and 1.7 mm thickness.

Full size image
Figure 3
figure 3

OCT of the right macula (a) before Avastin treatment, showing cystoid oedema, and (b) 3 weeks afterwards, when the oedema had resolved.

Full size image

Comment

To our knowledge, this is the first report of intravitreal Avastin treatment for VPRT. The injection was followed by a dramatic improvement within 3 weeks. Although the patient experienced sensory and motor weakness, no physical abnormality was detected.

This promising result warrants further studies to assess the efficacy of Avastin in the treatment of VPRT, and to determine whether repeated injections are required.