Abstract
Purpose. To evaluate functional and anatomic effects of intravitreal bevacizumab in patients with neovascular AMD and initial low visual acuity. Methods. Retrospective case series of 38 eyes with neovascular AMD and initial visual acuity of 20/200 or less, treated with intravitreal bevacizumab injection. Results. Mean followup was 14.1 months ± 7.1 (range: 5 to 24 months). Mean logMAR vision at baseline was 1.38 logMAR ± 0.33, at 6 months was 1.14 logMAR ± 0.37 (P = 0.001) and at 12 months was 1.22 logMar ± 0.33 (P = 0.004). Mean baseline central retinal thickness was 431 μm ± 159.7 at 6 months was 293.43 μm ± 122.79 (P = 10−4) and at 12 months was 293.1 μm ± 130 (P = 0.004). Visual acuity improved in both patients with or without prior PDT treatment. Conclusions. Intravitreal bevacizumab injection may increase the chance of visual acuity gain in neovascular AMD even in cases with initial low visual acuity.
Highlights
Since the vascular endothelial growth factor (VEGF) has been implicated as a major angiogenic stimulus responsible for the formation of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) drugs inhibiting the bioactivity of VEGF representing a new paradigm in the treatment of neovascular AMD [1]; MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration) [2] and ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration) [3] studies, both multicenter, randomized, double-masked trials, established the efficacy of ranibizumab (Lucentis) in improving visual acuity in patients with both classic and occult CNV
Subgroup analysis of the MARINA trial noted that the improvement in patients with initial visual acuity of 20/160 or less is lower than patients with better initial visual acuity
Bevacizumab (Avastin; Genentech, San Francisco, Calif, USA) is a full-length antibody against all VEGF-A isoforms which is approved for use in metastatic colon cancer and lately used for the treatment of AMD
Summary
Since the vascular endothelial growth factor (VEGF) has been implicated as a major angiogenic stimulus responsible for the formation of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) drugs inhibiting the bioactivity of VEGF representing a new paradigm in the treatment of neovascular AMD [1]; MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular Age-Related Macular Degeneration) [2] and ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration) [3] studies, both multicenter, randomized, double-masked trials, established the efficacy of ranibizumab (Lucentis) in improving visual acuity in patients with both classic and occult CNV Both studies excluded individuals with very low visual acuity (range, 20/40–20/320 in the MARINA study and 20/80–20/120 in the ANCHOR study) and patients previously treated with photodynamic therapy. Bevacizumab (Avastin; Genentech, San Francisco, Calif, USA) is a full-length antibody against all VEGF-A isoforms which is approved for use in metastatic colon cancer and lately used for the treatment of AMD.
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