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A. A. Castellarin, R. Avery, D. Pieramici, M. Rabena, M. Nasir, M. Giust; Intravitreal Bevacizumab (Avastin®) in the Treatment of Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):75.
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Long term retrospective study to evaluate the safety and efficacy of intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration (AMD).
A retrospective review of 102 consecutive patients receiving intravitreal bevacizumab for neovascular AMD was performed after institutional review board approval. Patients underwent complete ophthalmic evaluations including nonstandardized Snellen visual acuity, complete ophthalmic fluorescein angiography, and optical coherence tomography (OCT). Intravitreal bevacizumab (1.25 mg) was administered on a monthly basis until macular edema, subretinal fluid, and/or pigment epithelial detachments resolved.
This study evaluated 110 eyes of 102 patients (34 men and 68 women), the majority of whom had previous treatment with photodynamic therapy and/or pegaptanib. Follow-up ranged from 6 to 9 months with a mean of 6.7 months. Patients received between 1 and 7 injections, with a mean of 3.1 injections. The mean retinal thickness of the central 1 mm as measured by OCT decreased from a baseline of 344 um to 265, 266, and 254 um at 1, 3, and 6 months, respectively (P<0.0001). Mean visual acuity improved from 20/200 to 20/125+ at 1, 3, and 6 months(P<0.0001). Patients were retreated on an average of 2 months. After the fourth injection one patient developed uveitis which resolved without sequelae with topical steroids. In separate instance, a patient with a pigment epithelial detachment developed a rip one month after a bevacizumab injection. One patient died of pulmonary fibrosis 4 months after his last bevacizumab injection, but this event was felt to be unrelated to the injection. No other significant ocular or systemic side effects were observed.
Intravitreal bevacizumab is well tolerated in patients with neovascular AMD and it is associated with reduction in retinal edema and improvement in visual acuity. These changes occurred usually within one month of treatment and were maintained throughout the duration of the study. Further evaluation of bevacizumab for the treatment of macular degeneration is warranted.
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