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L. Vitale, L. Migliavacca, L. De Polo, N. Orzalesi; Dynamic Indocyanine Green Angiography (ICGA) of Choroidal Neovascularization (CNV) in Neovascular AMD, Treated With Intravitreal Injection of Bevacizumab (Avastin). Invest. Ophthalmol. Vis. Sci. 2007;48(13):4562.
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to evaluate vascular changes following intravitreal injection of bevacizumab in patients with neovascular AMD.
32 eyes of 30 patients suffering from occult or classic subfoveal CNV were treated with intravitreal injection of bevacizumab (1.25 mg). At baseline and 30 days after injection patients underwent ETDRS visual acuity (VA) examination, dynamic fluorescein angiography (FA) and ICGA with HRA scanning laser ophthalmoscope (Heidelberg Retinal Angiograph, Ottobrunn, Germany). ICGA and VA changes 30 days after injection were compared with retrospective series of PDT-treated eyes, matched for type of lesion, VA at baseline and follow-up.
30 days after bevacizumab injection, only 7 cases (22%) showed changes in ICGA pattern represented by disappearance of a part of the neovascular net in 5 eyes (5 classic CNV, 4 with no previous PDT and 1 with two previous PDT). 2 eyes (1 classic CNV with one previous PDT and 1 occult CNV with three previous PDT) showed FV reduction in calibre and perfusion delay.VA improved in 18 eyes (56%) (+2,33 ± 0,9 lines), did not change in 9 (28%), decreased in 5 (16%) (-2,5 ± 1 line). In eyes with no previous PDT, VA improved in 86%, did not change in 14%; in eyes with 1 to 3 previous PDT, VA improved in 70%, did not change in 20%, decreased in 10%; in eyes with 4 to 6 previous PDT, VA improved in 33%, did not change in 40%, decreased in 27%. In all groups, VA change did not correlate with CNV type (classic or occult).30 days after treatment mean VA change was +0,85 lines in classic and +0,93 lines in occult CNV in bevacizumab-treated group.In the PDT-treated retrospective series 30 days after treatment the neovascular net had disappeared in 40% of cases, mean VA changes was -0,90 lines in classic and -0,43 lines in occult CNV.
after intravitreal injection of bevacizumab, dynamic ICGA changes were present only in a minority of cases, whereas VA increased in more than half of cases. Conversely, PDT-treated cases showed better ICGA response to treatment with verteporfin, with less gain of VA.
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