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J. E. Kim, M. A. Genead, D. J. Covert; Comparison of Response to Intravitreal Bevacizumab Therapy in Eyes With Prior Treatment vs. No Prior Treatment for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3361.
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To compare the response to intravitreal bevacizumab (Avastin) in eyes that had prior treatment (PTx) for neovascular age-related macular degeneration (AMD) and eyes with no prior treatment (NTx) for AMD.
Charts, fluorescein angiograms (FA) and optical coherence tomography (OCT3) scans of patients who had been treated with intravitreal injections of 1.25mg/0.05ml of bevacizumab for neovascular AMD were retrospectively reviewed. The effect of bevacizumab therapy was compared between eyes that had been treated with other modalities of treatment for wet AMD versus no other treatments prior to receiving bevacizumab therapy. Main outcome measures were the changes in visual acuity (VA), central macular thickness, and leakage on FA at baseline (just prior to starting bevacizumab therapy) and at last follow-up visit.
PTx group consisted of 41 patients who had prior treatments that included photodynamic therapy (PDT), PDT and intravitreal triamcinolone, thermal laser, or pegaptanib. NTx group consisted of 35 patients who received bevacizumab as first line therapy. Average follow-up was 4.58+/-1.63 months (range: 2-8 months) with average of 2.8+/-1.2 injections (range: 1-7). For PTx group, the mean baseline VA prior to start of bevacizumab treatment and last VA were 20/190 and 20/114, respectively (p<0.0001). For NTx group, the mean baseline VA was 20/98 and last VA was 20/71 (p=0.005). The mean pretreatment and last visit OCT retinal thickness for PTx group were 326 µm and 249 µm, respectively (p<0.0001), while for NTx group was 275 µm and 203 µm, respectively (p<0.0001). The FA leakage at last visit was observed in 36.6% for PTx group and 11.4% in NTx group (p=0.011). VA improved by 0.221 logMAR units in PTx group and by 0.139 in NTx group (p=0.244). OCT retinal thickness improved after treatment for PTx and NTx groups by 77.2 µm and 77.1µm, respectively (p=0.737).
Both groups of eyes with prior or no prior treatment for neovascular AMD had visual and anatomical improvements following treatment with intravitreal bevacizumab. There was no difference in response between eyes that had received prior AMD therapy and those that had not in terms of improvements in VA or retinal thickness, but previously treated eyes were more likely to have persistent FA leakage at the last follow up.
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