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P. Salvetti, C. Detrez, J. Le Rouic, F. Becquet, D. Ducournau, C. Pousset-Caharel, E. Hermouet, P. Perronet, P. Verdy, C. Boscher; Poor Response After One Single Intravitreal Injection of Bevacizumab (Avastin ®) : What to Expect From Pre Operative Features Analysis?. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1792.
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To identify common features in clinical, angiographic and OCT examinations of patients showing no change at one month control after intravitreal Bevacizumab injection.To identify whether lack of improvement at one month can be predictive of outcome after retreatment(s).
Retrospective multicenter consecutive case series, reviewing charts of 445 patients (mean age 80,1 yo), 470 eyes, who received 1.25 mg (0.05 ml) intravitreal Bevacizumab (Avastin ®) for neovascular AMD, either as primary or secondary treatment. Informed consent was obtained; all patients underwent ETDRS visual acuity testing, ophthalmoscopy, angiography and OCT at baseline and at each follow-up visit. Data were analyzed by means of regression and multivariate correlation analysis.
30 eyes out of 470 (6.74%) showed no change in either BCVA, angiographic or OCT at one-month control visit. For this group, mean duration of disease was 14,7 months (0,5-38 mo) before first injection; 66,7% of those eyes had received argon laser, PDT, Triamcinolone, Pegaptanib (Macugen®) or a combination of those prior to first injection. 80% showed fibrosis, 60% hemorrhages, 60% PED, 47% OMC. Angiographic characteristic showed 20% classic lesions, 60% occult; 7% RAP, 13% anastomosis. Mean retinal thickness was 467 microns at baseline and 416 microns at one month. BVCA was 0,104 at baseline and 0,100 at one month. All 30 eyes were retreated, (mean number of injections: 3,5). After 6 months of follow-up 27% of those eyes showed improvement in either BCVA, angiographic or OCT examination.
Eyes presenting with long standing disease, previous treatment(s), poorer BCVA and fibrosis have poorer response to Bevacizumab at first month control. This may be related to drug delivery (dose, lesion fibrosis), or to angiographic characteristics at baseline. Angiography seems to be more sensitive than OCT at detecting response to Avastin®. Based on statistical analysis, one-month response does not seem to be predictive of outcome after repeated injections.
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