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F. Menchini, A. Polito, D. Roman Pognuz, N. Zemella, G. Polini, A. Mandurino, P. Lanzetta, F. M. Bandello; Intravitreal Bevacizumab (Avastin) for Subfoveal Myopic Choroidal Neovascularization Unresponsive to Prior Photodynamic Therapy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1454. doi: https://doi.org/.
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To report the short-term safety and efficacy of intravitreal bevacizumab (IVB) 1 mg in patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia (PM) unresponsive to prior photodynamic therapy (PDT).
15 consecutive eyes of 15 patients with subfoveal myopic CNV, unresponsive to at least one prior PDT, were prospectively enrolled in the study. Patients were considered unresponsive to PDT if 3 months after the last treatment an enlargement of the lesion and/or persistence of fluorescein leakage were noticed. Three consecutive intravitreal injections were performed on a monthly basis. Thereafter the need for additional injections was based on the following predefined retreatment criteria: persistence of fluorescein leakage and/or increase in lesion size. Main outcome measures were occurrence of treatment- related ocular or systemic complications, changes in best corrected visual acuity (BCVA), using ETDRS-like charts, changes in OCT and angiographic lesion characteristics.
The mean follow-up was 6 months (range 4-8). Mean baseline visual acuity was 20/80 (56.7 letters). Visual acuity increased to 20/40 (67.3 letters) at 3 months and was stable at the last follow-up, with a mean gain of 11 letters (p<0.001). At the last follow-up 4 patients (27%) had a visual improvement ≥20 letters, 4 (27 %) gained between 10 and15 letters, 5 (33%) between 5 e 10, 1 patient improved by 3 letters, and one lost 8 letters. Mean CNV thickness on OCT decreased from 227 µm at baseline to 177 µm, 144 µm and 141 µm at 1 and 3 months and at the last follow-up respectively (p<0.001). Mean CNV greater linear diameter (GDL) was 1624 µm at baseline, and decreased to 1426µm at 1 month, 1337µm at 3 months, 1364 µm at the last follow-up(p<0.001). One patient required a forth injection after developing a recurrence 4 months after the third injection. No ocular or systemic complications were noticed.
Short-term results suggest that intravitreal bevacizumab provides significant functional and anatomical improvement with no significant adverse events in patients with subfoveal myopic CNV unresponsive to prior PDT. Visual improvement began as early as 1 week after treatment and continued during the first 3 months, with a subsequent stabilization. 100% of patients presented a fluorescein leakage decrease, evident after a month. A good correlation between visual acuity and lesion characteristics on fluorescein angiography and OCT was noticed.
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