Journal List > J Korean Ophthalmol Soc > v.49(12) > 1008157

Kim, Kim, Yu, and Kwak: Long-term Effect of Intravitreal Bevacizumab for CNV Secondary to Age-Related Macular Degeneration

Abstract

Purpose

To investigate the long-term therapeutic effect and safety of repeated intravitreal bevacizumab injections for managing choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Methods

Clinical data of 14 eyes of 14 patients who were treated with repeated (3 times or more) intravitreal bevacizumab injections for secondary to AMD and followed up for 12 months were collected. Patients were treated with 1.25 mg of intravitreal bevacizumab. Bevacizumab was injected at 6-week intervals. Reinjection was performed with the same method according to the physician’s decision.

Results

Mean visual acuity change increased by 4.0 lines from 1.13±0.47 to 0.73±0.44 (LogMAR). Mean central retinal thickness change decreased by 114.8 µm from 240.3±123.8 µm to 125.5±39.4 µm. Visual acuity improved statistically significantly at 12 weeks after first intravitreal bevacizumab injections and was maintained for 12 months. Central retinal thickness decreased statistically significantly at 6 weeks after the first intravitreal bevacizumab injection and was maintained for 12 months. During the 12 months of 4 intravitreal bevacizumab injections, mean visual acuity change increased by 4.0 lines at 12 months and 4.4 lines at 7 months.

Conclusions

Intravitreal bevacizumab injection causes a significant decrease in central retinal thickness and improvement in visual acuity in eyes with CNV due to AMD for 12 months.

References

1. Ferris FL. 3rd. Senile macular degeneration: Review of epidemiologic features. Am J Epidemiol. 1983; 118:132–51.
crossref
2. Ferris FL 3rd, Fine SL, Hyman L. Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol. 1984; 102:1640–2.
3. Bressler NM, Bressler SB, Fine SL. Age-related macular degeneration. Surv Ophthalmol. 1988; 32:375–413.
crossref
4. Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: 5-year results of two randomized clinical trials with an open-label extension: TAP report no. 8. Graefes Arch Clin Exp Ophthalmol. 2006; 244:1132–42.
5. Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol. 2001; 119:198–207.
6. Verteporfin In Photodynamic Therapy Study Group Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization--verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2001; 131:541–60.
7. Lee HJ, Kang JE, Lee JH. A Case report of acute visual decrease due to choroidal nonperfusion after photodynamic therapy. J Korean Ophthalmol Soc. 2005; 46:1411–8.
8. Leung DW, Cachianes G, Kuang WJ. . Vascular endothelial growth factor is a secreted angiogenic mitogen. Science. 1989; 246:1306–9.
crossref
9. Plate KH, Breier G, Weich HA, Risau W. Vascular endothelial growth factor is a potential tumour angiogenesis factor in human gliomas in vivo. Nature. 1992; 359:845–8.
crossref
10. Rosenfeld PJ, Moshfeghi AA, Puliafito CA. Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration. Ophthalmic Surg Lasers Imaging. 2005; 36:331–5.
crossref
11. Spaide RF, Laud K, Fine HF. . Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 2006; 26:383–90.
crossref
12. Yoganathan P, Deramo VA, Lai JC. . Visual improvement following intravitreal bevacizumab (Avastin) in exudative age-related macular degeneration. Retina. 2006; 26:994–8.
crossref
13. Goff MJ, Johnson RN, McDonald HR. . Intravitreal bevacizumab for previously treated choroidal neovascularization from age-related macular degeneration. Retina. 2007; 27:432–8.
crossref
14. Ladas ID, Kotsolis AI, Papakostas TD. . Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration. Retina. 2007; 27:891–6.
crossref
15. Stifter E, Michels S, Prager F. . Intravitreal Bevacizumab Therapy for Neovascular Age-related Macular Degeneration with Large Submacular Hemorrhage. Am J Ophthalmol. 2007; 144:886–92.
crossref
16. Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev. 2004; 25:581–611.
crossref
17. Avery RL, Pieramici DJ, Rabena MD. . Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006; 113:363–72.
crossref
18. Chen CY, Wong TY, Heriot WJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration: a short-term study. Am J Ophthalmol. 2007; 143:510–2.
crossref
19. Lazic R, Gabric N. Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 2007; 245:68–73.
crossref
20. Falkenstein IA, Cheng L, Morrison VL. . Standardized visual acuity results associated with primary versus secondary bevacizumab (avastin) treatment for choroidal neovascularization in age-related macular degeneration. Retina. 2007; 27:701–6.
crossref
21. Rosenfeld PJ, Brown DM, Heier JS. . Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1419–31.
crossref
22. Brown DM, Kaiser PK, Michels M. . Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1432–44.
crossref
23. Bakri SJ, Snyder MR, Reid JM. . Pharmacokinetics of intravitreal bevacizumab (Avastin). Ophthalmology. 2007; 114:855–9.
crossref
24. Bakri SJ, Snyder MR, Reid JM. . Pharmacokinetics of intravitreal ranibizumab (Lucentis). Ophthalmology. 2007; 114:2179–82.
crossref
25. Smith BT, Dhalla MS, Shah GK. . Intravitreal injection of bevacizumab combined with verteporfin photodynamic therapy for choroidal neovascularization in age-related macular degeneration. Retina. 2008; 28:675–81.
crossref
26. Bashshur ZF, Haddad ZA, Schakal A. . Intravitreal Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: A One-year Prospective Study. Am J Ophthalmol. 2008; 145:249–56.
crossref

Figure 1
. Mean (±SD) change in visual acuity letter scores through 48 weeks (5 letters=1 line).
jkos-49-1935f1.tif
Figure 2
. Change in central retinal thickness from baseline to 48 weeks in all treated eyes.
jkos-49-1935f2.tif
Table 1.
Patient demographics, changes in visual acuity and number of injections
Patients Sex Age Pretreatment VA (LogMAR) VA at 12 month (LogMAR) VA change ( LogMAR) Number of injections Lesion type GLD
1 M 79 0.76 0.30 -0.46 7 Occult 3120
2 F 77 1.40 0.82 -0.58 6 Occult 3850
3 M 61 0.86 0.80 -0.06 3 MC 3500
4 F 72 0.86 0.70 -0.16 3 Occult 3210
5 M 77 1.10 1.10 0 3 MC 3450
6 M 86 0.74 0.10 -0.64 3 PC§ 1820
7 M 58 0.64 0.30 -0.34 3 Occult 2410
8 M 69 2.00 0.40 -1.6 5 Occult 1010
9 M 59 1.80 1.00 -0.8 5 Occult 1250
10 F 69 0.52 0.52 0 3 PC§ 2010
11 F 65 1.26 1.26 0 3 Occult 2750
12 M 80 1.20 1.04 -0.16 5 Occult 4650
13 M 69 0.90 0.22 -0.68 4 Occult 2520
14 F 66 1.80 1.70 -0.1 3 Occult 1170
Mean 70.5 1.13 0.73 -0.40 4.0 2623

VA=visual acuity;

GLD=greatest linear dimensionn

MC=minimally classic

§ PC=predominantly classic.

Table 2.
Patient demographics, changes in central retinal thickness and number of injections
Patients Sex Age Pretreatment CRT (µm) CRT at 12 month (µm) CRT change (µm) Number of injections Lesion type GLD
1 M 79 273 174 -99 7 Occult 3120
2 F 77 179 180 1 6 Occult 3850
3 M 61 343 101 -242 3 MC 3500
4 F 72 218 74 -144 3 Occult 3210
5 M 77 191 113 -78 3 MC 3450
6 M 86 332 140 -192 3 PC§ 1820
7 M 58 547 121 -426 3 Occult 2410
8 M 69 333 212 -121 5 Occult 1010
9 M 59 115 126 11 5 Occult 1250
10 F 69 241 107 -134 3 PC§ 2010
11 F 65 78 85 7 3 Occult 2750
12 M 80 148 132 -16 5 Occult 4650
13 M 69 263 99 -164 4 Occult 2520
14 F 66 103 93 -10 3 Occult 1170
Mean 70.5 240.3 125.5 -114.8 4.0 2623

CRT=central retinal thickness

GLD=greatest linear dimension

MC=minimally classic

§ PC=predominantly classic.

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