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P. Yoganathan, D. M. Fastenberg, P. J. Ferrone; Intravitreal Bevacizumab 2.5mg versus 1.25mg in Exudative Age-Related Macular Degeneration: Safety and Efficacy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3357.
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To review the safety and short-term efficacy of 2.5 mg intravitreal bevacizumab compared to 1.25 mg for recurrent choroidal neovascularization (CNV) in age-related macular degeneration.
Retrospective case series. Patients were treated with either 2.5 mg or 1.25 mg intravitreal bevacizumab. Visual acuity, anatomic response, blood pressure, and systemic side effects were noted.
Mean visual acuities (logmar equivalent) for 25 patients treated with 2.5 mg were 20/220 and 20/181 at initial and final visits respectively (no statistical difference p=0.45). These patients had a mean follow-up time of 6.2 months (range, 3-9 months). Seven patients (28%) required re-injection at one month for persistent disease. Nine patients (36%) developed recurrence at an average of 3.0 months after initial injection (range 2- 6 months). Seven patients (28%) remained disease-free for the available length of follow-up, mean 4.1 months (range 3-6 months). Mean visual acuities for 31 patients treated with 1.25 mg bevacizumab were 20/200 and 20/160 at initial and final visits respectively (p=0.4). These patients had a mean follow-up time of 7.7 months (range, 6-12 months) Twenty-seven patients (90%) underwent re-treatment at one month. Fifteen patients (48%) developed recurrence at a mean of 5.9 months follow-up (range, 3-10 months). Three patients (10%) remained disease-free for length of follow-up (mean follow-up 7 months, range 6-8 months). There was no incidence of endophthalmitis, change in blood pressure, thromboembolic event, or death in either group.
In our case series, patients injected with higher doses of bevacizumab required fewer injections in the short term. 84% of patients injected with 1.25 mg bevacizumab required a second injection at one-month follow-up compared to only 28% of patients injected with 2.5 mg bevacizumab. Despite there being a persistent anatomical improvement in subretinal fluid and/or hemorrhage with the 2.5 mg dose, average initial and final visual acuities did not differ statistically in either group. This may be attributed to retinal damage secondary to their chronic disease. Our case series suggests that a higher dose of bevacizumab results in an anatomic improvement of active disease in patients who have failed prior treatment. Intravitreal bevacizumab 2.5 mg appears to be safe in the short-term and suggests a persistent treatment effect compared to 1.25 mg.
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