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K. C. Madhusudhana, S. R. Hannan, A. J. Lotery, A. J. Luff, R. S. B. Newsom; Effect of Intravitreal Bevacizumab (Avastin) on the Size of Lesion and Area of Leakage in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4572.
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To evaluate the effect of intravitreal bevacizumab on the size of lesion and area of angiographic leakage in neovascular age-related macular degeneration (AMD).
A retrospective chart review of patients treated with intravitreal bevacizumab 1.25 mg for choroidal neovascularisation (CNV) secondary to AMD was performed. Clinical examination, best-corrected visual acuity, fundus fluorescein angiography and optical coherence tomography were performed at baseline and follow-up visits. The total area of the lesion (inclusive of CNV, subretinal haemorrhage, retinal elevation and scarring) was measured on fluorescein angiogram as per a previous study. The size of CNV (area of active leakage) was measured for classic, predominantly classic and minimally classic CNV.
32 patients (33 eyes) were included in the study. There were twenty-seven eyes with subfoveal CNV (classic=7, predominantly classic=3, minimally classic= 6 and occult= 11) and five eyes with serous pigment epithelial detachment. One patient had peripapillary CNV. In total, 62 injections were given (mean number of injections per patient= 1.88). Follow-up averaged 4.4 months (range: 1- 7 months). The mean visual acuity score (ETDRS letters) at baseline was 46.4. The total area of the lesion reduced from 3.88 disc areas (DA) at baseline to 3.15 DA at final follow-up (P=0.0001, Student’s t-Test). The CNV size reduced from 1.64 DA to 0.24 DA at final follow-up (P=0.004, Student’s t-Test). At final follow-up, the mean visual acuity score improved to 52.3 (P= 0.08). 18.2% of eyes achieved ≥15 letters improvement, 69.7% had stable vision (loss or gain of <15 letters) and 12.1% lost ≥ 15 letters of vision. The mean reduction in central macular thickness was 93 µm. Two patients suffered ocular side effects but no systemic adverse effects were noted.
Intravitreal bevacizumab appears to be effective in reducing the size and activity of the neovascular complex and, improving vision in patients with neovascular AMD. Randomised controlled trials are warranted to confirm these findings.
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