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R. S. Yuson, N. Nigam, L. Cheng, W. Freeman; Prognostic Implications of Pigmented Epithelial Detachment in Bevacizumab (Avastin) Treated Eyes With Age-Related Macular Degeneration and Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5563.
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To evaluate the response to Primary Avastin Treatment of eyes with Age-Related Macular Degeneration (AMD) & Choroidal Neovascularization (CNV) with large Pigment Epithelial Detachment (PED) component and to compare the increase in visual acuity (VA) & resorption of retinal fluid to eyes with CNV in AMD with Minimal to no PED component.
We reviewed 33 patients with CNV and AMD on primary Avastin therapy. There were 14 eyes with large PED component in AMD with CNV lesion and 19 eyes with minimal to no PED in AMD with CNV lesion eyes. Only patients with no prior treatment for AMD and those started on purely intravitreal Avastin treatment were taken in the study. Measurements regarding PED size, time to PED collapse and retinal fluid resolution were made using Stratus OCT scans every 2 months with 6 months follow-up period as the endpoint. All eyes evaluated in the study had ETDRS VA, baseline ophthalmologic examination, fundus photos, fluorescein angiography and Stratus OCT every 2 months with monthly bevacizumab therapy. Time to resolution of retinal fluid between the large PED and no PED group, as well as the time to resolution of PED versus retinal fluid within the large PED group were compared using survival analysis. VA improvement was compared across the groups using both t test and fisher's exact test.
In AMD with CNV eyes having a large PED component, retinal fluid resolves faster than the PED fluid (p=0.032). The PED fluid itself is highly resistant, mean average decrease in PED size during the 6 month period was 34%. The retinal fluid absorption rates were similar in the two groups (mean time of 151 vs. 128 days, p=0.2 Cox regression with the number of injections adjusted). The VA improvement was significantly different between large PED group and no PED groups (1 letter vs 11 letters, p=0.01 t test)
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