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A. Prasad, Z. Ahmad, R.D. Patel, B.E. Jones; Intravitreal Bevacizumab in the Treatment of Exudative AMD . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5224.
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To evaluate the effects of intravitreal Bevacizumab in exudative AMD. Vascular Endothelial Growth Factor (VEGF) is a mediator of angiogenesis and has been shown to be an important stimulus in exudative AMD. Bevacizumab (Avastin, Genentech) is a recombinant humanized, full length, anti–VEGF monoclonal antibody that binds to all isoforms of VEGF–A.
This is a retrospective interventional case series of 16 patients with exudative AMD who were treated with intravitreal Bevacizumab 1.0 mg. Patients treated were between 50–86 years of age who had predominately classic (2) or predominately occult (14) subfoveal CNV with exudative changes as determined by clinical exam and fluorescein angiography (FA). Pre–treatment visual acuity (VA) ranged from 20/40 to 2/200. Baseline best–corrected VA, FA, blood pressure, and medical history were obtained. Seven patients were examined with ocular coherence tomography (OCT, Zeiss). An expanded informed consent with an off–label use waiver and explanation letter was reviewed with all patients. Eyes were prepped using topical anesthetic and fluoroquinolone antibiotic drop followed by 5% betadine. A trans pars–plana intravitreal injection of 0.04ml of 25mg/ml bevacizumab (1.0mg) was performed and antibiotic drops were prescribed QID for 1 week. Follow up was planned at 1 and 6 weeks, with FA obtained at 6 weeks.
One week follow up was obtained in 11 of 14 eyes with improved visual acuity of 1 Snellen line seen in 2 cases and no change in the remainder. Subretinal fluid was clinically decreased in 4 eyes with OCT confirmation seen in 3 of 3 cases measured. Six week follow–up was obtained in 12 patients at the time of this abstract submission. Improved visual acuity from 1 to 4 Snellen lines was seen in 6 patients and stabilization seen in the remaining. There was decreased FA leakage and reduced subretinal fluid in all patients examined at this time point (12), with confirmation by OCT in all 5 patients measured. Flattening of a large retinal pigment epithelial detachment (RPED) was seen in 2 cases. One patient was found to have minimal vitritis with no iritis. No systemic events occurred.
Intravitreal Bevacizumab produced a rapid reduction of exudation in wet AMD both clinically and on FA in all patients with 6 week follow up. OCT confirms subretinal fluid is largely resolved and RPED flattened in patients studied. Imrovement in visual acuity from 1– 4 Snellen lines is seen in 50% (6/12) of patients at six weeks. More follow up is needed to demonstrate that this is a safe method for treatment of exudative AMD.
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