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T. Nuzzo, L. Migliavacca, S. De Cillà, M. Alkabes, N. Orzalesi; Intravitreal Injection of Bevacizumab (Avastin) in Age-Related Choroidal Neovascularization With and Without "Plaques" in Late Phases of Dynamic Indocyanine Green Angiography (ICGA). Invest. Ophthalmol. Vis. Sci. 2008;49(13):314.
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To evaluate the efficacy of intravitreal injection of Bevacizumab in patients with neovascular age-related macular degeneration with and without "plaques" in late phases of dynamic indocyanin green angiography (ICGA).
15 eyes of 14 consecutive patients (9 females, 5 males; mean age 75 years) suffering from occult or classic subfoveal choroidal neovascularization (CNV) (12 occult and 3 predominantly classic) with "plaque" in late phases of indocyanin green angiography (ICGA) and 18 eyes of 17 consecutive patients (11 females, 6 males; mean age 78; 12 occult and 6 predominantly classic) without "plaque", were treated with intravitreal Bevacizumab (1.25mg). Patients underwent ETDRS visual acuity (VA) examination, dynamic fluorescein angiography (FA) and ICGA with HRA scanning laser ophtalmoscope (Heidelberg Retinal Angiograph, Heidelberg) and OCT (Stratus, Zeiss) at baseline (visit 1) and 30 days after injection (visit 2). Particular attention was given to the presence or absence of fluorescent "plaques" in late phases (30’- 40’) of ICGA with HRA. At baseline mean visual acuity in patients with "plaque" was 20/60, whereas mean visual acuity in patients without "plaque" was 20/56. At visit 2 if leakage at FA or retinal thickening at OCT were still present, the patients underwent a second intravitreal injection. A third complete ocular examination (visit 3) was performed 60 days from baseline.
Patients with "plaques" showed a mean VA increase of 1.5 lines at visit 2 and of 1.8 lines at visit 3. A decrease of leakage at FA and of retinal thickness at OCT was present in 8 out of 15 cases (mean OCT decrease 105 µm at visit 2 and 115 µm at visit 3), whereas there were no changes at ICGA. Patients without "plaques" showed a mean VA increase of 0,6 lines at visit 2 and of 0.7 lines at visit 3. A decrease of leakage at FA and of mean retinal thickness (80 µm at visit 2 and 90 µm at visit 3) were present in only 2 patients. The difference in final visual acuity between patients with and without "plaques" was statistically significant (P = 0.017, t-test).
After injection of intravitreal Bevacizumab, improvement of VA and decrease of retinal thickness at OCT were higher in patients with "plaques". This maybe related to the slow progression and lower aggressivity of CNV with "plaques".
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