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Y. J. Daoud, S. Stinnett, G. J. Jaffe; Predicting the Outcome of Bevacizumab in the Treatment of Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2008;49(13):262.
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To study the anatomic and physiologic effect of intravitreal bevacizumab on choroidal neovascularization (CNV) in neovascular age-related macular degeneration (NVAMD) and to determine whether pre-treatment clinical variables, optical coherence tomography (OCT) findings, and fluorescein angiography (FA) findings correlate with subsequent improvement in visual acuity and reduction in retinal edema after intravitreal bevacizumab injection.
A retrospective review of 89 eyes of 85 patients treated between August 2005 and April 2007 with intravitreal bevacizumab (IVB) for CNV secondary to NVAMD was performed. Pre- and post-treatment clinical data were recorded. OCT scans were assessed for central foveal thickness (CFT), morphologic edema pattern, cystoid space size, subfoveal fluid, and presence of retinal pigment epithelium detachment (PED) at the time of the initial injection, at 1,2,3,6 and 12 months and at the end of follow up. Visual acuity measurements were obtained using Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Statistical analyses were conducted to determine correlations among pre- and post-treatment variables. Any ocular or systemic adverse events were recorded.
89 eyes of 85 pts were followed for a mean of 13 months. Sixty-one eyes had greater than 1-year follow-up. Of these, 51 (84%) lost fewer than 3 lines of visual acuity, and of these, 12 eyes (20%) gained at least 3 lines and 26% (43%) remained stable . Over this time, CFT improved significantly ( p <0.0001). Pre-treatment VA was significantly correlated with post-treatment VA ( p <0.0001). Thinner pre-treatment CFT was associated with a greater percentage improvement in VA ( p <0.0001), as well as a thinner final CFT (p<0.0001). Time between diagnosis of NVAMD and injection of bevacizumab as well as number of bevacizumab injections were correlated with final BCVA, but this association was not statistically significant ( p =0.09). Family history of AMD, personal history of hypertension or smoking, or previous treatment with agents other than bevacizumab were not predictive of final BCVA or CFT.
Short-term results after intravitreal bevacizumab treatment for NVAMD showed improved BCVA and CFT in patients with CNV secondary to AMD. Pre-treatment variables that correlate with favorable outcome include BCVA and CFT. These data will help provide a more accurate prognosis to patients when they are counseled prior to bevacizumab injection.
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