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F. Ziemssen, B. Voykov, F. Gelisken, M. Leitritz, M. Völker, W. Inhoffen, K. U. Bartz-Schmidt; Morphological Outcome of Intravitreal Bevacizumab Treatment for Neovascular AMD: 12-Month Follow-Up of Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):333.
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To report the 12-month results of morphometric response to intravitreal bevacizumab treatment for neovascular age-related macular degeneration.
In this retrospective study, 71 consecutive patients with subfoveal CNV were included who underwent intravitreal bevacizumab injections between September 2005 and October 2006. Intravitreal bevacizumab injections were performed either as primary treatment procedure or following failure by other therapies. All patients had repeated optical coherence tomography (OCT) measurements at baseline and follow-up examinations. Analysis of images was done by two observers totally blinded to the clinical data. High inter-observer agreement was confirmed (P<0.001) before values were taken into statistic analysis. Fluorescein angiography was available at baseline and was repeated if necessary. Primary outcome measurement was the change in central retinal thickness (CRT) and the presence of pigment epithelium detachment (PED).
71 patients (49 female, 22 male, mean age: 77.6 years) were treated by intravitreal bevacizumab injections (average 3.1; range 1-6). All patients had a follow-up of 12 months. Mean CRT decreased from 276 µm (95%-CI: 250.0-301.4 µm) at baseline to 220 µm (95%-CI: 198.4-241.0 µm) at 12 month (P<0.001). Mean decrease was -57 µm, which corresponds to a mean reduction of 56% (95%-CI: 30.4-82.6%) relative to the initial CRT. Change of CRT was independent of the number of injections (P=0.3227) and lesion type (P=0.235), but baseline values were positive predictors of the response to bevacizumab (P<0.001). A significant number of patients (22.5%) presented with an initial reduction of CRT below 180µm. Even 38.0% showed retinal thinning at the 12-month examination.By just evaluating for the presence of PED, there was no eminent improvement. Final OCTs still showed a PED in 33/71 (46.5%) patients with 25 (71.4%) persistent and 8 (22.2%) new PED, in contrast to the initial frequency of 49.3% (35/71).
In the present retrospective, non-comparative study, CRT improved for the majority of the eyes within the one year following the intravitreal bevacizumab treatment. However, persistent PED and signs of retinal atrophy make the assessment of the quantitative parameters more difficult and restrict the agreement with the functional results.
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