Short-term Efficacy of Intravitreal Bavacizumab for Polypoidal Choroidal Vasculopathy

Ho Lee Min; Hwan An Jin; Eun Lee Ji; Sub Oum Boo

doi:10.3341/jkos.2009.50.1.51

Journal List > J Korean Ophthalmol Soc > v.50(1) > 1008516

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Min, Jin, Ji, and Boo: Short-term Efficacy of Intravitreal Bavacizumab for Polypoidal Choroidal Vasculopathy

Original Article

J Korean Ophthalmol Soc 2009;50(1):51-60.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.51

Short-term Efficacy of Intravitreal Bavacizumab for Polypoidal Choroidal Vasculopathy

Ho Lee Min, M.D, Hwan An Jin, M.D, Eun Lee Ji, M.D, PhD, M.D, Sub Oum Boo, M.D, PhD

Department of Ophthalmology, Pusan National University Hospital, College of Medicine, Pusan, Korea

Address reprint requests to Boo Sub Oum, MD, PhD Department of Ophthalmology, Pusan National University Hospital #1 Ga 10, Ami-dong, Seo-gu, Pusan 602-739, Korea Tel: 82-51-240-7326, Fax: 82-51-242-7341, E-mail: bsoum@pusan.ac.kr

Received 21 October 2008 Accepted 13 June 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 evaluate the short-term effect of intravitreal bevacizumab (Avastin^Ⓡ) in polypoidal choroidal vasculopathy. Methods: Intravitreal Avastin^Ⓡ was injected into 13 eyes of 13 patients with PCV in this retrospective, interventional case study. The follow-up period lasted over 3 months after therapy. Changes in best-corrected visual acuity (BCVA), foveal height determined by optical coherence tomography, and abnormal vasculature in indocyanine green angiography (ICGA) were evaluated.

Results

The mean LogMAR BCVA was 0.82 at baseline, 0.78 at 1 month after treatment, and 0.73 at 3 months after treatment. Visual acuity was stabilized or improved in 13 eyes (100%). The mean foveal height was 288 µm at baseline, 231 µm (p<0.05) at 1 month after treatment, and 196 µm at 3 months after treatment. The polypoidal lesions in ICGA decreased in 4 eyes (31%), although branching vasculature in ICGA was unchanged in 13 eyes (100%).

Conclusions

Intravitreal injection of Avastin^Ⓡ may stabilize visual acuity and reduce macular edema due to decreased retinal pigment epithelial detachment and leaking. However, intravitreal injection had a minimal effect in occlusion of the symptomatic polypoidal lesions and no effect in occlusion of the branching vascular network.

Keywords: Bevacizumab, Polypoidal choroidal vasculopathy

References

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Figure 1.

Change in logarithm of the minimum angle of resolution (LogMAR) best-corrected visual acuity (VA) with time (months). Improvements of three or more lines of VA were detected in 2 eyes (case 6 and 8).

Figure 2.

Change in mean fovea thickness with time (months). A significant decrease was found at 1 month (p<0.05).

Figure 3.

Case No. 3 (A) Baseline fundus photograph shows hard exudates, pigmentations around macula. (B) Baseline horizontal OCT image and (C) vertical OCT image shows protruding polyps and macular edema. (D)~(F) One month after the second injection, macular edema reduced, but subretinal hemorrhage occurred.

Figure 4.

Case No. 3 (A) Baseline ICGA shows polypoidal dilatation of choroidal vessels and branching vascular network. (B) ICGA of one month after the second injection, the actively stained polyps resolve completely (arrows) while branching vascular network remains.

Figure 5.

Case No. 6 (A) Baseline fundus photograph shows orange nodular lesion at temporal area from fovea. (B) Baseline horizontal OCT image and (C) vertical OCT image shows subretinal fluid. (D~F) One month after the third injection, subretinal fluid resolved.

Figure 6.

Case No. 6 (A) Baseline ICGA shows polypoidal dilatation of choroidal vessels and branching vascular network. (B) ICGA one month after the third injection, the polyps resolved incompletely (arrows).

Figure 7.

Case No. 12 (A) Baseline fundus photograph shows orange nodular lesion at nasal area from fovea. (B) Baseline horizontal OCT image and (C) vertical OCT image shows multiple PED and polyps. (F~H) One month after the second injection, PED reduced. (D) Baseline FA shows leaking at corresponding region of the fundus, and pooling at PED region. (I) FA of one month after the second injection shows reduced leaking. (E) Baseline ICGA shows polypoidal dilatation of choroidal vessels (arrows). (J) ICGA of one month after the second injection, the vascular findings did not change.

Figure 8.

Case No. 12 (A) Fundus photograph of seven month after the second injection. (B) Horizontal OCT image and (C) vertical OCT image shows increased PED. (D~ F) One month after the third injection, PED reduced.

Figure 9.

Case No. 12 (A) Baseline ICGA shows hidden area due to hemorrhage PED (broken arrows). (B) ICGA of one month after the second injection, the vascular findings did not change (arrows). (C) ICGA of one month after the third injection shows increased polypoidal lesion (arrowhead).

Figure 11.

Case No. 13 (A) Baseline ICGA shows polypoidal dilatation of choroidal vessels hidden area due to hemorrhage PED (arrows). (B) ICGA of one month after the second injection, the polyps remain, but activity decreased. (C) ICGA of six month after the second injection shows increased polypoidal lesion (arrowhead).

Figure 10.

Case No. 13 (A) Baseline fundus photograph shows orange nodular lesion around macula. (B) Baseline horizontal OCT image and (C) vertical OCT image shows PED, polyp and subretinal fluid (D~F) One month after the second injection, PED and subretinal fluid reduced. (G~ I) Six month after the second injection, subretinal fluid increased.

Table 1.

Patient characteristics and clinical date before and after intravitreal injection of bevacizumab for PCV

Case No.	Age	Sex	Previous PDT^∗	Pre Tx BCVA^†	Post Tx BCVA	Pre Tx fovea thickness(µm)	Post Tx fovea thickness(µm)	Polyp closure	Branching network closure	F/U mo	No of reinjection
1	81	F	Yes	0.02	0.02	282	241	No	No	6	2
2	72	F	No	0.125	0.32	316	182	Yes	No	6	3
3	70	M	No	0.32	0.32	215	132	No	-	5	2
4	59	M	No	0.2	0.2	292	198	No	No	3	0
5	58	M	Yes	0.1	0.2	258	211	Yes	No	8	3
6	74	M	No	0.2	0.25	420	126	Yes	No	4	2
7	64	F	No	0.4	0.32	205	203	No	No	4	1
8	64	M	Yes	0.04	0.02	347	254	No	No	8	1
9	70	F	Yes	0.02	0.02	400	148	No	No	8	3
10	83	F	No	0.25	0.32	196	163	No	No	4	2
11	59	M	No	1.0	1.0	220	280	Yes	No	4	2
12	68	M	No	0.3	0.6	245	210	No	No	8	2
13	73	F	No	0.125	0.16	232	201	No	-	8	1

^∗ PDT=photodynamic therapy;

^† BCVA=best corrected visual acuity; -undetermined.

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