Abstract

FR.13.08

Bevacizumab for neovascular age-related macular degeneration (ARMD) with detachment of the retinal pigment epithelium (RPE): Success rate and complications

Schulze C., Buechner T., Wiechens B.
Eye Hospital, Klinikum Region Hannover

Objective: Patients with neovascular ARMD and detatchment of the RPE are an unfavourable prognostic group since PDT is not indicated and tears of the RPE can occur after intravitreal injections. The purpose of this study is to investigate the efficacy and safety of intravitreal Bevacizumab in patients with ARMD and RPE detatchment.
Methods: 57 patients (59 eyes) with neovascular ARMD and RPE detatchment were treated with 1-3 (mean 2,5) intravitreal Bevacizumab injektions (1,25 mg). Minimum postoperative follow-up was 4 weeks (mean 108±56 days). Preoperative examination and visits after 4 and 12 weeks included tests for visual acuity, fluorescein angiography and OCT.
Results: Mean preoperative acuity was 0,86±0,38 logMAR, mean central retinal thickness was 327±105 mm. After 4 weeks an average increase in acuity of -0,06±0,24 logMAR and after 12 weeks an increase of -0,09±0,23 logMAR were noted. In 42% of the treated eyes an improvement in acuity of 2 lines or more was achieved. An average reduction in central retinal thickness of 56±94 mm was found after 4 weeks and a reduction of 100±114 mm after 12 weeks. OCT showed a marked decrease (n=9) or disappearance (n=17) of the RPE detatchment. Postoperative complications were tears of the RPE (n=3), macular hole (n=1), glaucoma deterioration (n=2), temporary rise in IOP (n=1) and cutaneous pruritus (n=1).
Conclusions: These preliminary results suggest that intravitreal Bevacizumab is an effective therapy with an acceptable complication rate for neovascular ARMD with RPE detatchment. Under certain conditions they might be offered as an alternative to anti-VEGF agents that are recently approved and available. The duration of the therapeutic effects and the proportion of patients requiring further therapy are still unknown. Prospective studies about safety and efficacy on larger numbers of patients are recommended.

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