Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration

Se Beum Oh; Won Bin Cho; Jun Woong Moon; Hyung Chan Kim

doi:10.3341/jkos.2009.50.2.202

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Oh, Cho, Moon, and Kim: Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration

Original Article

J Korean Ophthalmol Soc 2009;50(2):202-210.

Published online: 3 January 2009

DOI: https://doi.org/10.3341/jkos.2009.50.2.202

Effects and Prognostic Factors of Intravitreal Bevacizumab Injection on Choroidal Neovascularization from Age-Related Macular Degeneration

Se Beum Oh, MD, Won Bin Cho, MD, Jun Woong Moon, MD, Hyung Chan Kim, MD, PhD

Department of Ophthalmology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

Address reprint requests to Hyung Chan Kim, MD Department of Opthalmology, Konkuk University Medical Center, Konkuk University School of Medicine #4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea Tel: 82-2-2030-5270, Fax: 82-2-2030-5273, E-mail: eyekim@kuh.ac.kr

Received 28 December 2007 Accepted 28 August 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the effects and prognostic factors related to intravitreal injection of bevacizumab on patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration.

Methods

The medical records of patients who received 3 consecutive intravitreal injections of bevacizumab (1.25 mg/0.05 ml, 6 weeks interval) for subfoveal choroidal neovascularization secondary to age-related macular degeneration and followed up for more than 12 months were reviewed (a total of 31 eyes; male, 20; mean age, 72.3±7.5 years). Baseline best corrected visual acuity, foveal thickness, and total macular volume were compared with those after 1, 4, and 12 months. The therapeutic effects were investigated with regard to factors such as age, sex, initial visual acuity, lesion size, subtypes of choroidal neovascularization, pigment epithelial detachment, submacular hemorrhage, and previous history of photodynamic therapy.

Results

Initial visual acuity (logMAR), foveal thickness, and total macular volume were 0.74±0.49, 320±88 μm and 9.50±2.99 mm³, respectively. Visual acuity improved to 0.68±0.61 (p=0.012), and foveal thickness and total macular volume decreased to 218±69 μm and 6.32±0.71 mm³ (p<0.001), respectively, at 12 months. Visual improvement was achieved less often in patients who were 75 years or older and who had lesions 3 disc areas or greater and relatively good initial vision at 12 months.

Conclusions

Intravitreal bevacizumab injection has beneficial effects for patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration with regard to function and anatomy. However, it should be noted that visual improvement may be limited in older patients with larger lesions and good initial vision.

Keywords: Age-related macular degeneration, Choroidal neovascularization, Intravitreal bevacizumab injection

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Figure 1.

Changes in visual acuity (logMAR), foveal thickness, total macular volume during follow-up.

Figure 2.

Comparision of visual acuity, foveal thickness, total macular volume between predominantly classic and occult subfoveal choroidal neovascularization secondary to AMD during the 12-month follow-up. No statistically significant differences were shown between two groups.

Figure 3.

Comparision of visual acuity, foveal thickness, total macular volume depending on presence of PED during the 12-month follow-up. No statistically significant differences were shown between two groups.

Figure 4.

Comparison of the ratio of subjects gaining 1 line or more at 12-month follow-up depending on ^* p is age, sex, lesion size, SMH, VA, prior PDT; statistically significant on Chi-square test of variances; DA=disc area; SMH=submacular hemorrhage; logMAR= logarithm of the minimum angle of resolution; VA=visual acuity; PDT=photodynamic therapy.

Table 1.

Baseline features of patients with subfoveal CNV due to age-related macular degeneration

	Baseline (%)
Eyes	31
Mean age± SD	72.3±7.5
< 75 years	20 (64.5)
≥ 75 years	11 (35.5)
Women	10 (32.2)
CNV^＊ subtype
predominantly classic	8 (25.8)
minimally classic	1 (3.2)
Occult	22 (71.0)
PED^†	10 (32.2)
Submacular hemorrhage	14 (45.2)
Size of lesion (DA^‡)
< 3 DA	13 (41.9)
≥ 3 DA	18 (58.1)
Prior PDT^§	16 (51.6)

^＊ CNV=choroidal neovascularization;

^† PED=pigment epithelial detachment

^‡ DA=disc area

^§ PDT=photodynamic therapy.

Table 2.

Comparison of the effects depending on various factors

			VA^‡ (logMAR^§)				Foveal thickness (μm)				Total macular volume (mm³)
			base	1 mo	4 mo	12 mo	base	1 mo	4 mo	12 mo	Base	1 mo	4 mo	12 mo
	< 75 (20 eyes)		0.65±0.45	0.58±0.43	0.58±0.45	0.58±0.71	328±95	251±67	218±52	223±49	9.80±3.30	7.12±1.40	0 6.33±0.76	6 6.43±0.59
		p^*		0.011	0.046	0.032		0.003	<0.001	<0.001		0.001	<0.001	<0.01
Age (years)	≥ 75 (11 eyes)		0.91±0.50	0.88±0.48	0.89±0.47	0.88±0.53	311±71	226±50	221±59	233±41	9.67±3.19	6.99±2.23	3 6.44±1.43	3 6.54±1.11
		p^*		0.180	0.285	0.341		0.003	0.016	0.011		0.003	0.006	0.014
		p^†	0.133	0.036	0.041	0.036	0.703	0.338	0.887	0.731	0.887	0.528	0.951	0.812
	Male (20 eyes)		0.52±0.52	0.46±0.50	0.45±0.52	0.46±0.49	290±74	220±63	216±54	228±58	8.13±2.85	6.77±1.03	3 6.36±0.82	2 6.59±1.43
		p^*		0.026	0.034	0.047		0.004	<0.001	0.008		<0.001	<0.001	<0.001
Sex	Female (11 eyes)		0.70±0.41	0.54±0.39	0.69±0.38	0.68±0.43	360±94	243±58	200±56	239±83	9.95±3.65	6.88±2.42	2 6.47±1.36	6 6.77±2.01
		p^*		0.048	0.197	0.127		0.003	0.013	0.049		0.003	0.006	0.019
		p^†	0.227	0.359	0.081	0.104	0.087	0.169	0.761	0.641	0.212	0.555	0.951	0.843
	< 0.53 (18 eyes)		0.39±0.15	0.35±0.14	0.38±0.19	0.38±0.10	334±91	245±67	212±50	221±61	10.26±3.65	7.21±1.87	7 6.32±1.11	1 6.63±1.47
Initial VA (logMAR)		p^*		0.034	0.422	0.571		0.003	0.001	0.007		0.001	0.001	0.001
	> 0.53 (13 eyes)		1.23±0.36	0.81±0.38	0.82±0.41	0.80±0.24	306±79	239±57	230±60	247±52	9.06±2.45	6.89±1.52	2 6.43±0.95	5 6.77±1.44
		p^*		0.036	0.041	0.037		0.002	0.013	0.009		0.002	0.004	0.009
		p^†	<0.001	<0.001	<0.001	<0.001	0.373	1.000	0.183	0.104	0.514	0.567	0.373	0.249
	≤ 3 (13 eyes)		0.71±0.46	0.64±0.40	0.63±0.40	0.62±0.31	300±72	243±70	223±68	241±41	8.82±3.18	6.95±2.03	3 6.59±1.22	2 6.71±1.45
		p^*		0.016	0.044	0.032		0.023	0.016	0.021		0.002	<0.001	0.001
Lesion size (DA)	3 – 6 (17 eyes)		0.52±0.52	0.52±0.54	0.52±0.56	0.53±0.50	327±97	232±55	204±36	220±39	9.86±3.31	6.81±1.45	5 6.12±0.82	2 6.31±1.49
		p^*		0.109	0.680	0.209		<0.001	<0.001	0.002		<0.001	<0.001	0.004
		p^†	0.073	0.044	0.036	0.041	0.798	0.352	0.196	0.243	0.921	0.312	0.211	0.197
	Present (14 eyes)		0.67±0.47	0.59±0.43	0.59±0.41	0.60±0.38	362±97	271±57	217±51	228±53	10.60±4.00	7.81±2.03	3 6.32±0.79	9 6.53±1.01
		p^*		0.042	0.048	0.053		0.002	<0.001	0.003		0.002	<0.001	<0.001
SMH^Π	Absent (17 eyes)		0.81±0.51	0.76±0.51	0.76±0.50	0.77±0.37	289±68	218±60	221±61	233±54	9.06±2.54	6.47±1.29	9 6.41±1.27	7 6.59±1.04
		p^*		0.039	0.049	0.051		0.004	0.013	0.019		<0.001	0.002	0.005
		p^†	0.421	0.279	0.262	0.311	0.032	0.002	0.984	0.814	0.356	0.029	0.984	0.847
	Present (16 eyes)		0.69±0.51	0.63±0.51	0.62±0.54	0.62±31	293±56	228±49	229±52	238±47	8.56±1.91	6.46±0.90	0 6.37±0.82	2 6.49±0.67
		p^*		0.041	0.039	0.043		<0.001	0.004	0.007		<0.001	0.002	0.010
Prior PDT^#	Absent (15 eyes)		0.80±0.49	0.74±0.44	0.73±0.44	0.73±0.40	322±89	242±64	219±56	235±30	11.03±4.03	7.72±2.23	3 6.37±1.31	1 6.51±0.97
		p^*		0.041	0.046	0.048		<0.001	<0.001	<0.001		0.003	0.002	0.005
		p^†	0.830	0.922	0.264	0.314	0.299	0.247	0.129	0.197	0.110	0.626	0.626	0.641

^* Statistical significances were tested by Wilcoxon signed rank test sign test of variance among base and follow up groups

^† Statistical significances were tested by repeated measured ANOVA of variances among groups;

^‡ VA=visual acuity;

^§ logMAR=logarithm of the minimum angle of resolution;

^Π SMH=submacular hemorrhage;

^# PDT=photodynamic therapy.

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