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A. Almony, G. K. Shah, K. J. Blinder; Limited Intravitreal Bevacizumab in the Treatment of Choroidal Neovascular Membranes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):296.
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To evaluate visual outcomes after a limited number of intravitrealbevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) injections in treatment-naïve eyes with choroidal neovascular membranes.
Of a total 1068 consecutive eyes that had received intravitreal bevacizumab injections for choroidal neovascular membranes, 106 treatment-naïve eyes (in 104 patients) receiving one to three intravitreal bevacizumab injections at the Barnes Retina Institute (St. Louis, Missouri) between October 2005 and September 2007 were included in this retrospective review. Best-corrected Snellen visual acuity (BCVA), funduscopic examination, and intravenous fluorescein angiography were obtained before intravitreal bevacizumab injection and at regular intervals after injections.
In the 106 treatment-naïve eyes receiving limited intravitreal bevacizumab injections for choroidal neovascular membranes, 93 (87.7%) eyes were diagnosed with age-related macular degeneration (AMD); 6 (5.7%) presumed ocular histoplasmosis syndrome; 3 (2.8%) idiopathic; 2 (1.9%) pathologic myopia; and 1 (0.9%) each pattern dystrophy and multifocal choroiditis. Patient age ranged from 25-97 years (median 79.5 years). Of 106 eyes, 55 (51.9%) received one injection, 33 (31.1%) received two injections, and 18 (17%) received three injections. Pre-treatment BCVA ranged from 20/25 to hand motion (HM) (median 20/200). Final post-treatment BCVA ranged from 20/20 to no light perception (NLP) (median 20/100). The average change in BCVA for all patients was +0.9 lines. Lesions that were small (≤3 disc areas), predominantly classic, and/or extrafoveal had the best median pre- and post-treatment visual outcomes. Overall, 28 eyes (26.4%) achieved ≥20/40 BCVA at the final post-treatment exam. The average follow-up was over 8 months (range 3-24 months) after the final injection.
The data from this retrospective study suggests that limited intravitreal bevacizumab is an effective treatment for choroidal neovascular membranes, resulting in stable or improved visual acuity. Limited intravitreal bevacizumab injections resulted in improved BCVA (≥2 lines) in 39 eyes (36.8%) and stable BCVA (≤1 line change) in 54 eyes (50.1%).
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