Multiple Recurrences of CNV Activity Occur in Majority of Eyes After Aggressive Monthly Avastin Monotherapy in AMD Patients

Abstract

Purpose: : To evaluate the time to healing in treatment naïve wet AMD patients and the time to recurrence after discontinuation of aggressive Avastin treatment.

Methods: : This is a prospective study done at Jacobs Retina Center, University of California, San Diego. 42 eyes of 41 patients with newly diagnosed wet AMD were included in the study. Patients previously treated with PDT, macugen or subretinal kenalog were excluded. All patients had ETDRS visual acuity testing and received intravitreal Avastin injections every 4 weeks. OCT and FA was performed every 8 weeks. Eyes were treated until they healed (i.e. dry on OCT, improved and stable visual acuity and no significant leakage on FA). Patients were then closely followed off treatment with ETDRS vision testing, OCT and FA. Recurrences were retreated with a similar treatment protocol. Recurrence was defined as a drop in visual acuity with new fluid on OCT and/or leakage on FA. Patients who did not heal were categorized as either non-responders or partial responders. Time to primary healing and time to recurrence were evaluated using Kaplan Meier curves.

Results: : The median time to primary healing with Avastin for 42 treatment naïve eyes was 134 days with a visual acuity improvement by a mean of 1.9 lines. After discontinuing the Avastin treatment for healed patients, 50% had primary recurrence at a median time of 297 days. The patients who recurred were retreated and the time to secondary healing was 153 days. Visual acuity showed less improvement by a mean of 1.4 lines after the second course of treatment.

Keywords: age-related macular degeneration • vascular endothelial growth factor • choroid: neovascularization