Intravitreal Bevacizumab (Avastin) for Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Abstract

Purpose:: to report the short-term safety and efficacy of three intravitreal injections of bevacizumab 1mg (IVB) on a monthly basis in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Methods:: this was a single-site, prospective, open-label, nonrandomized trial. 30 eyes of 30 patients with subfoveal CNV secondary to AMD, either unresponsive to prior treatments or unlikely to respond to photodynamic therapy were enrolled in the study. All patients received 3 intravitreal injections on a monthly basis with additional monthly injection base on predefined retreatment criteria. Retreatment criteria were: decrease in visual acuity of 5 letters and any fluid on OCT, or persistent or increased intra- or subretinal fluid on OCT, or new hemorrhage, or development of new classic CNV. Main outcome measures were occurrence of treatment- related ocular or systemic complications, mean change in best corrected visual acuity (BCVA), change in foveal thickness (NFT) and overall macular architecture on OCT, change in the total area of neovascular complex and in the total area of leakage from CNV.

Results:: a total of 96 injections was performed with no evidence of systemic or ocular side effects, except for 2 RPE tears, after the 1^st and 2^nd injection respectively. Mean BCVA improved from 20/200-2 at baseline to 20/160+2 at 3 months, with a mean improvement of 5, 6 and 9 letters at 1, 2 and 3 months respectively. 53%, 43% and 60% of the patients at 1, 2 and 3 months respectively gained >5 letters, while an improvement >15 letters was observed in 10% at 1 month, 27% at 2 months and 30% at 3 months. Visual improvement was sustained up to the 4^th month and was stable at 5 months (19 patients). Both lesion and leakage areas were significantly reduced at 3 months compared to baseline, with a mean decrease in lesion area of 25% and in fluorescein leakage of 44%. A progressive reduction in neurofoveal thickness was observed in 22% of cases and 36% of cases at 1 and 3 months respectively. 37% of patients needed re-injection at 3 months. Half the patients who were not reinjected at 3 months recurred at 6 months and required further injection.

Conclusions:: preliminary, short-term results suggest that IVB provides functional and morphological improvement with no significant adverse events in patients with subfoveal CNV secondary to AMD unresponsive to prior treatments or not amenable to conventional therapies.

Keywords: age-related macular degeneration • choroid: neovascularization • clinical (human) or epidemiologic studies: outcomes/complications