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Z. Lazrak, P. Bonnin, A. Erginay, J.-A. Pournaras, S.-Y. Cohen, P. Massin, A. Gaudric; Ultrasound Assessment of Short Term Ocular Vascular Effects After Intravitreal Injection of Bevacizumab (Avastin®) for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1877.
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Intra ocular antiangiogenic drugs are widely used to treat neovascular Age Macular Degeneration(AMD) and various vascular retinal diseases. Although their efficacy in neovascular AMD is well demonstrated, their possible effect on choroidal and retinal blood flow of eyes affected by choroidal new vessels has not been thoroughly studied. In this pilot prospective non comparative study, we explored Blood flow velocity in central retinal artery (CRA), posterior ciliary arteries (TPCA) and ophthalmic artery (OA) of eyes treated with Bevacizumab.
In 15 patients with neovascular AMD, color Doppler Ultrasonography (Sonoline Elegra,Siemens ) was performed to measure time-average mean blood flow velocities (MeanBFV) in CRA,TPCA and OA, before and 4 weeks after a single intravitreal injection of 1.25 mg bevacizumab . The same measures were made in the fellow eye. Visual acuity (VA) measurement and Optical Coherence Tomography (OCT Stratus, Zeiss Meditec) examination were performed before injection and 4 weeks after .
Bevacizumab injection was followed by a significant VA improvement (20/125 to 20/80; p=0.0214), and a decrease in mean central macular thickness on OCT(392 ± 96 to 271 ± 50 µm; p=0.0038). Mean BFV decreased by 10% in the CRA (p=0.0226), 20% in TPCA (p=0.0026), and 20% in OA (p=0.0003). No effect was observed in fellow eyes.
Although intravitreal bevacizumab injection significantly improves VA and decreases macular thickness in eyes with neovascular AMD, color Doppler Ultrasonography showed a decrease in blood flow velocities CRA, TPCA and OA, as a side effect of the treatment. This suggests that antiangiogenic therapy could alter the perfusion of the native choroidal and retinal vascular bed. The clinical long term significance of these findings remains to be determined.
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