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J. M. Colina-Luquez, P. E. Liggett, G. Haffner, N. A. Chaudhry; Intravitreal Bevacizumab Injection As A Rescue Therapy In Patients With Previously Treated Choroidal Neovascularization Secondary To Wet Macular Degeneration.. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3366.
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to analyze retrospectively the results of intravitreal Bevacizumab injection for wet age-related macular degeneration (ARMD) in patients without previous treatment and those who had been treated with the triple therapy (TT) of intravitreal triamcinolone injection, Verteporfin based PDT and pegaptanib sodium injection.
The study included 49 patients (54 eyes). Informed consent was obtained and HIPPA requirements were followed. There were two groups of eyes: Newly treatment group, treated only with intravitreal Bevacizumab (Avastin®)( n= 25) and prior treatment group, treated with TT at least 3 months prior to Bevacizumab (n=29). At base line and at the 4 weeks follow-up, patients in both groups had VA measurement (Snellen chart), slit-lamp biomicroscopy with IOP measurement and, 90D ophthalmoscopy, fluorescein angiography and OCT. The re-treatment consisted in repeating intravitreal Bevacizumab injection, 4 weeks apart as required.
Follow-up ranged from 2 to 4 months (mean 3 months). In the newly treatment group, the mean visual acuity change was an improvement of 3.8 lines; (statistically significant Wilcoxon signed-ranks test, P = 0.015). In the prior treatment group (TT), the mean change was an improvement of + 0.9 lines (P = 0.45). In the newly treatment group, 38% of the eyes had an improvement of 3 or more lines and only 5.86% in the prior group. Re-treatment rates were 2.5 for the new treatment group and 2.8 for the prior treatment group. The mean macular thickness measured by OCT pre- treatment was 296 + 102.76 (194 to 398 microns) and 301 + 117 (184 to 419 microns) for the prior and newly treatment groups respectively; post-treatment OCT was mean 235 + 60.37 (range 175 to 310 micros) and 224 + 36.44 (188 to 263 microns) for the prior and newly treatment groups respectively. This was statistically significant (Wilcoxon signed-rank test, P = .006) between pre and post-treatment and between both of the groups (P=.003). During follow-up, none of the patients increased the intraocular pressure (IOP) of > 20 mmHg. None of the eyes developed endophthalmitis.
Intravitreal Bevacizumab therapy seems to be effective in improving anatomical configuration of the fovea in both groups. The best visual outcome was obtained in the newly treatment group. Bevacizumab seems to be an effective therapy for the treatment of ARMD, particularly when used as first-line therapy while when it’s used as a rescue therapy it doesn’t seem to have an important advantage as compare with the current available therapies.
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