Abstract
Purpose::
To evaluate the effect of intravitreal bevacizumab treatment on pigment epithelial detachment (PED) due to neovascular age-related macular degeneration (AMD), and to identify prognostic factors for regression of PED and improvement in visual acuity.
Methods::
Twenty-one patients (21 eyes) with active CNV from neovascular AMD with PED were identified from a retrospective chart review from November, 2005 to July, 2006. A cohort of 25 AMD patients with CNV without PED was chosen randomly for comparison of change in retinal thickness in response to treatment. All patients received 3 intravitreal injections of bevacizumab (1.25 mg) during a 3 month period. Patients were examined at baseline and after each treatment using optical coherence tomography (OCT). Maximal PED height and area were analyzed using Image J software. Minimal retinal thickness was measured by calipers using the OCT software. Changes in PED dimensions were correlated with changes in retinal thickness and visual acuity.
Results::
Mean baseline visual acuity in eyes with PED was 20/143, and the mean visual acuity of non-PED eyes was 20/168. Baseline mean minimal retinal thickness in PED eyes was 901 microns, and baseline mean minimal retinal thickness in non-PED eyes was 577 microns. The average baseline PED area was 400.9 microns. PED eyes experienced a decline of 25.4% in total retinal thickness after one injection, and a total decline of 26.4% after three injections. In comparison, non-PED eyes experienced a decline of 26.9% after one injection and 33.5% after three injections. PED area decreased by 32.3% after one injection, and by 35.5% after three injections. After three treatments, 83% of eyes retained a PED. Visual acuity after 3 treatments was 20/149 in PED eyes and 20/146 in non-PED eyes. Initial PED size was correlated to poorer anatomical and visual response.
Conclusions::
Intravitreal bevacizumab treatment was associated with a modest decrease in PED dimensions in patients with neovascular AMD. In a majority of patients, PED persisted despite repeated treatments with intravitreal bevacizumab. Initial PED size was found to be a negative predictive factor for treatment response and visual outcome.
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)