Abstract
Purpose To evaluate the concentration of vascular endothelial growth factor (VEGF) in aqueous humor after a single intravitreal injection of bevacizumab (IVB) in eyes with neovascular age-related macular degeneration (AMD).MethodsIn this prospective interventional case series study, 24 eyes of 24 patients with types 1 and 2 choroidal neovascularization secondary to neovascular AMD were treated with a single intravitreal injection of bevacizumab. Aqueous humor samples were obtained before the intravitreal injection and at one week, one month, and three months follow-up periods. Best-corrected visual acuity (BCVA) and three spectral-domain optical coherence tomography parameters (central retinal thickness, macular volume and macular area) were also analyzed and correlated with VEGF expression at the baseline and each follow-up period.ResultsAll of the ninety-six aqueous humor study taps were well tolerated by the study patients without adverse events. Increased VEGF levels (mean ± SD = 179.7 ± 88.3 pg/mL) were observed in the aqueous humor of all study patients before the intravitreal injection of bevacizumab. At all follow-up periods, compared to baseline, levels of VEGF significantly reduced (P < 0.0001), and BCVA significantly improved (P < 0.005). The lowest VEGF expression was observed at 1 week, and the greatest BCVA improvement occurred 1 month after treatment. At 1 month, central retinal thickness (CRT), macular volume (MV), and macular area (MA) significantly reduced compared to baseline (P < 0.0001, P = 0.0005, P = 0.007, P = 0.009, respectively). At 1 week and 3 months, although without statistical significance (P > 0.005), CRT, MV and MA also reduced in comparison to baseline.ConclusionsSingle intravitreal bevacizumab injection in eyes with neovascular AMD resulted in a substantial decrease of aqueous VEGF levels 1 week after treatment with the greatest improvement of clinical outcomes occurring at 1 month follow-up.
Highlights
Neovascular age-related macular degeneration (AMD) is the main cause of severe visual loss among individuals older than 55 years in developed countries [1, 2]
Intravitreal injection of bevacizumab was administered exclusively to the patients presenting with neovascular AMD
Increased vascular endothelial growth factor (VEGF) expression in the vascular endothelial cells and retinal pigment epithelial cells has been reported in eyes with active Choroidal neovascularization (CNV) due to neovascular AMD [20], and VEGF suppression by anti-VEGF agents has been shown to be effective for treating CNV secondary to AMD [24]
Summary
Neovascular age-related macular degeneration (AMD) is the main cause of severe visual loss among individuals older than 55 years in developed countries [1, 2]. A variety of randomized and controlled clinical trials have shown that intravitreal injections of VEGF antibodies, either bevacizumab, ranibizumab or aflibercept, are an effective approach of treatment in patients with neovascular AMD [11,12,13]. These trials demonstrated that anti-VEGF agents are able to decrease the intraocular VEGF level, causing regression of CNV and reducing retinal and choroidal leakage. Anti-VEGF agents are related to visual acuity improvement and central retinal thickness (CRT) thinning in neovascular AMD patients [11, 13]
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