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R. Radhakrishnan, C. Zatezalo, F. Esmail, R. M. Lieberman, R. M. Fischer; Long Term Visual Outcomes in Patients Receiving Intravitreal Bevacizumab (Avastin). Invest. Ophthalmol. Vis. Sci. 2008;49(13):5583.
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We examined the efficacy and long-term outcomes in patients receiving intravitreal bevacizumzab (Avastin®) (IVA) for multiple etiologies in a diverse clinic population.
A retrospective review of 105 patients (120 eyes) receiving IVA (1.25mg/0.05ml) was conducted. The main outcome measures included best-corrected visual acuity (BCVA), need for further treatment, and complications. Data was collected at 1, 3, 6, and 12 months (mo). Initial and final BCVA (12 mo) were calculated and expressed in logMar and patient years.
One hundred and five patients (120 eyes) were included: 66 male, 39 female, 57 Hispanics, 32 Asians, 8 Caucasians and 8 African Americans. Initial and final BCVA ranged from 20/20 to NLP (logMAR 0-3). IVA was used to treat proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME), vitreous hemorrhage (VH), retinal vein occlusion, and macular degeneration.In 16 eyes with VH, the initial mean BCVA was 20/293 (logMAR 0-2.301), was 20/55 (logMAR 0.176-0.699) at 3 mo, and final BCVA was 20/54 (logMAR 0.301-0.602). Halving of the visual angle was noted at 3 mo. Four repeat IVA injections were needed in 3 patients.Patients with CSME (25 eyes) had an initial mean BCVA of 20/103 (logMAR 0.301-2). At 6 mo BCVA was 20/59 (logMAR 0.097-0.875), and returned to near baseline of 20/117 at 12 mo (logMAR 0.301-1.301). There was a near halving of the visual angle between 3 and 6 months. Two patients required additional IVA, and 10 patients received focal laser.In 39 eyes with PDR, the initial BCVA was 20/341 (logMAR 0.699-2.699) and was 20/122 (logMAR 0.176-2.301) at 1 mo, and 20/149 (logMAR 0.097-2.301) at 12 mo. There was a near halving of the visual angle within the first month. Eight of these patients required additional IVA, 2 received pan retinal photocoagulation, and 2 underwent vitrectomy.Complications noted in our study included glaucoma, epiretinal membrane, vitreo-retinal traction syndrome, and cataracts, in addition to progression of the primary disease. There were no cases of endophthalmitis.
IVA appears to be a useful treatment modality in this patient population. Patients with PDR appeared to derive the most benefit early on. Those with CSME tended to return to baseline BCVA despite additional treatment. Amongst the subgroups that were studied, patients with VH benefited the most and regained visual acuity that was sustained at 1 year. Further investigation is warranted.
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