Intraocular Bevacizumab (Avastin) for the Treatment for Choroidal Neovascularization and Retinal Vasculopathies

Abstract

Purpose: : To evaluate the efficacy and safety of intravitreal bevacizumab as either rescue therapy or primary treatment for choroidal neovascularization and retinal vasculopathies.

Methods: : A retrospective review was conducted on eyes with choroidal neovascularization and retinal vasculopathies that were treated at either eye center with intravitreal bevacizumab (1.25mg in 0.05ml) between August 2005 and December 2005. Assessment of treatment efficacy was determined using optical coherence tomography (OCT) and Snellen visual acuity both pre and post treatment.

Results: : 111 eyes of 108 patients with a mean age of 72 years (range 43 to 96) underwent 182 intravitreal injections with bevazicumab for choroidal neovascularization due to macular degeneration (80 eyes), myopia (7 eyes), presumed ocular histoplasmosis (1 eye), angioid streaks (2 eyes), IJTA (2 eyes), or idiopathic causes (1 eye). Injections were also used to treat diabetic macular edema (8 patients) and vein occlusions (9 patients). Macular degeneration patients were further subclassified as either macugen failures (30 eyes), non macugen failures (including photodynamic therapy or prior macular laser treatment) (27 eyes), or primary treatment with Avastin (23 eyes). Pre–injection VA measured: less than 20/400 (29 eyes) or 20/250 – 20/400 (23 eyes), 20/100 – 20/200 (29 eyes), 20/40–20/80 (29 eyes), or > 20/40 (0 eyes). 1 month follow–up was available for 72 eyes. At 1 month all patient groups, except those treated for diabetic macular edema, demonstrated improvement in standardized central foveal thickness (SCFT) as determined by OCT: overall (41.2% improvement), macular degeneration (36% improvement) [macugen failures (40.1%), non macugen failures (36.1%), primary treatment with Avastin (31.8%)], myopia (53.3% improvement), idiopathic CNV(34.3 % improvement), vein occlusions (30.3% improvement), and diabetic macular edema (5.1% worsening). Injection complications were limited to corneal abraisions in 3 patients and no drug–related side effects were observed.

Conclusions: : At 1 month intravitreal bevazicumab appears to produce a significant reduction in standardized central foveal thickness for choridal neovascularization due to varying etiology, as well as vasculopathies due to vein occlusions. Additional follow–up is needed to determine if repeated treatment with Avastin results in further reductions of standardized central foveal thickness and eventual improvement in patients’ vision.

Keywords: retina • injection