Abstract

FR.13.06

When is the end point for intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration?

Pogorelov P., Bergua A., Knorr H., Kruse F. E., Mardin C. Y.
Department of Ophthalmology, University of Erlangen-Nuremberg, Germany

Objective: To determine, how many intravitreal bevacizumab (Avastin) injections are necessary to stabilize or to improve the visual acuity in patients with neovascular age-related degeneration (AMD).
Methods: Interventional, consecutive, retrospective case series of 56 eyes of 55 patients with sub/juxtafoveolar neovascular AMD. 45 eyes (80.3%) showed an occult membrane with or without pigment epithelial detachment (PED), 11 eyes (19.7%) had classic or mixed choroidal neovascularisation. In 11 eyes, previous photodynamic therapy remained unsuccessful. All patients received standardized single 1.0 mg intravitreal bevacizumab injection (off-label). Ophthalmic evaluation, included Snellen visual acuity (VA), standardized ophthalmic examination and optical coherence tomography (OCT), were performed one week after the injection and then monthly (mean follow-up 21 weeks). Depending on a change in visual acuity and in morphological findings, repeated injections were performed. Stable vision was defined as a change of initial visual acuity ± one Snellen line, the improvement of visual acuity as a change in two lines or more.
Results: 38 eyes (67.6%) were treated with a single bevacizumab injection. 18 of 38 eyes (47.4%) showed stable vision and 16 eyes (42.1%) experienced an improvement of visual acuity. Four eyes with unfavourable initial situation showed decreased visual acuity at the end of the mean follow-up of 17.8 weeks. 11 of 56 eyes (19.6%) were treated with second injection 16.5 weeks after the first injection. In seven eyes, the third injection (at mean ten weeks after the second injection) was necessary. In one eye, a pigment epithelium rip was observed during the follow-up. In all groups, the best visual acuity was achieved one week after the intravitreal injection, decreasing at the end of the follow-up.
Conclusions: 60.7% of all treated patients with neovascular age-related macular degeneration experienced even after a single injection improvement or stabilization of the visual acuity. 76.8% needed two and 84% up to three injections. 16% of the patients showed no response to the treatment.

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