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E. X. Fu, R. P. Singh, S. D. Smith, D. R. Williams, P. K. Kaiser; Predicative Factors for Visual and Anatomical Outcome After Intravitreal Bevacizumab Treatment of Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4532.
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To evaluate the predictive factors for visual and anatomical outcomes after intravitreal bevacizumab (Avastin, Genentech) injection in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
A retrospective review of 62 eyes of 62 patients with CNV secondary to AMD who received intravitreal bevacizumab (1.25mg) for subfoveal CNV due to AMD. All patients were treated with intravitreal bevacizumab at baseline and at six-week intervals based on best corrected Snellen visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT) assessment. The main outcome measures were improvement in BCVA and central foveal thickness (CFT) measured manually using the Stratus OCT machine from baseline. Secondary outcome measures were lesion composition, lesion thickness, CNV thickness, pigment epithelial detachment thickness, and subretinal fluid thickness.
Fifty-nine (95.2%) patients had inadequate response to previous CNV treatments of photodynamic therapy (26, 42.6%), pegaptanib (27, 44.3%), and/or photocoagulation (6, 9.8%) and were started on intravitreal bevacizumab therapy. The mean baseline BCVA was 20/177 and CFT was 290 µm. At 3 months, mean BCVA and CFT improved to 20/148 and 208 µm respectively (p<0.001). At 6 months, mean BCVA was stable at 20/163 while CFT continued to improve to near normal thickness of 189 µm (p<0.001). All CNV types including predominately classic, minimally classic and occult with no classic showed BCVA and CFT improvement at three and six months. None of the outcome measures were positive predictive factors for better visual or anatomic outcomes. In contrast, the presence of subretinal hemorrhage on fluorescein angiography and subretinal fluid on OCT evaluation showed the least improvement.
Short-term results after intravitreal bevacizumab treatment for neovascular AMD showed improved BCVA and CFT in patients with all CNV types. Patients with subretinal hemorrhage and subretinal fluid showed the least improvement. Further studies are necessary to confirm the long-term predicative factors of this new treatment.
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