Is monthly retreatment with intravitreal bevacizumab (Avastin) necessary in neovascular age-related macular degeneration?

Nicola G Ghazi, Tyler Q Kirk, Robert M Knape, James S Tiedeman, Brian P Conway, Nicola G Ghazi, Tyler Q Kirk, Robert M Knape, James S Tiedeman, Brian P Conway

Abstract

Purpose: To report our short-term experience with bevacizumab in neovascular age-related macular degeneration (AMD) and recommend a new treatment strategy.

Methods: Retrospective chart review of 29 consecutive patients receiving 1.25 mg of intravitreal bevacizumab for AMD and completing 12 weeks of follow up. Outcome measures were best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness. Injections were repeated if no further improvement was observed.

Results: Twenty-nine eyes of 29 patients were included. The average BCVA improved from 20/148 at baseline to 20/106 at twelve weeks (P = 0.041). Of the 29 eyes, 25 (86.2%) had stable or improved BCVA. Average mean central macular thickness measured by OCT improved from 351 mum at baseline to 278 mum at 12 weeks (P = 0.003). Stabilization of vision and improved OCT central macular thickness were maintained for at least eight weeks following only a single injection in the majority of eyes. During the three months of follow up, only five eyes (17.2%) required repeat injections, with only three (10.3%) requiring retreatment at eight weeks and none at four weeks. No significant ocular or systemic side effects were observed.

Conclusion: This short-term data suggests that bevacizumab appears to be a safe and effective treatment for neovascular AMD. Injections as frequent as every month do not appear to be necessary since initial treatment effect appears to be maintained for at least eight weeks in almost all of our patients.

Keywords: AMD; Avastin®; bevacizumab; neovascular age-related macular degeneration; retina.

Figures

Figure 1
Figure 1
Change in visual acuity 12 weeks after initial treatment with bevacizumab (scatter plot). Note: All dots below the line indicate eyes with improved vision. Abbreviation: LogMAR, logarithm of the minimal angle of resolution.
Figure 2
Figure 2
Change in average best-corrected Snellen visual acuity (VA) over time following initial treatment with bevacizumab. Notes: The majority of the change occurred in the first 4 weeks following treatment with stabilization afterwards. P values at each follow up visit were obtained by comparing with baseline (P value less than 0.05 indicates statistical significance).
Figure 3
Figure 3
Change in average central macular thickness (CMT) as measured by optical coherence tomography (OCT) 12 weeks after initial treatment with bevacizumab (scatter plot). Note: All dots below the line indicate eyes with reduced CMT.
Figure 4
Figure 4
Fundus photos (left column), late fluorescein angiography frames (middle column) and optical coherence tomography (OCT; right column, same orientation scan in all three images) at presentation (upper row), eight weeks (middle row) and 12 weeks follow up (lower row) of the right eye of a patient with good response to bevacizumab. Following only one injection of bevacizumab, best-corrected visual acuity (VA) and central macular thickness (CMT; in microns) improved from 20/667 and 420 microns at presentation to 20/25 and 208 microns and to 20/60 and 307 microns at eight and 12 weeks, respectively. Notes: Note absence of leakage on angiography with total resolution of intra-and-subretinal fluid on OCT by eight weeks following a single injection of bevacizumab. Retreatment was performed at 12 weeks because of worsening vision, active leakage along the superior border of the neovascular lesion and increased CMT (third row).
Figure 5
Figure 5
Change in average central macular thickness (microns) over time as measured by optical coherence tomography (OCT) following initial treatment with bevacizumab. Notes: The majority of the change occurred in the first two weeks following treatment with stabilization afterwards. P values at each follow-up visit were obtained by comparing with baseline (P value less than 0.05 indicates statistical significance).
Figure 6
Figure 6
Number of eyes that required repeat bevacizumab injections during the three-month follow-up period. Note: Only five out of 29 eyes required repeat injections.
Figure 7
Figure 7
Breakdown of the eyes and the various types of treatment rendered prior to bevacizumab. Twenty of 29 eyes (69.0%) had received prior treatment. The majority of eyes received photodynamic therapy prior to bevacizumab.

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Source: PubMed

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