Subjektives Empfinden nach intravitrealer Bevacizumab-Injektion

Abstract

The group of anti-VEGF drugs is a new option for ophthalmologists in the therapy for acute and chronic macular oedema. First studies have revealed a stabilisation and increase of best corrected visual acuity as well as a decrease of retinal thickness, objectively measured with optical coherence tomography. The effects on subjective sensations are not always correlated with the objective changes. From May to July 2006, 43 patients were treated with 1.25 mg bevacizumab, administered by sterile intravitreal injection. 30 patients had an age-related macular degeneration, 9 patients a diabetic retinopathy with macular oedema, 3 patients had a chronic macular oedema caused by retinal vessel occlusion and one patient had a retinal pigment detachment. The age ranged from 45 to 84 years (median: 70 years). General and special ophthalmological anamnesis, best corrected visual acuity and retinal thickness measured by optical coherence tomography were taken. Complete follow-up examinations were performed four and eight weeks after injections. In these postoperative controls the patients were also asked about their subjective sensations after the injection of bevacizumab, controlled by means of a numerical rating scale. The best corrected visual acuity (ETDRS) decreased from 9.2 letters (range from 0 to 40) to 13.1 letters (range from 0 to 42; p < 0.05) after four weeks, further four weeks later to 15.8 letters (range from 0 to 44; p < 0.05). The subjective sensations increased significantly at four weeks (0.54 points; range from - 1 to + 3; p < 0.05) and at eight weeks light regression (0.28 points; range from - 3 to + 3; p < 0.05). All patients reported a brightening "dark central blot". The available metamorphopsias improved at four weeks (18 patients), and at eight weeks 5 patients reported improvement. For none of ther patients did the metamorphopsia disappear completely. The intravitreal injection of bevacizumab shows beneficial results in terms of an increase of best corrected visual acuity. However, on comparing these results with the subjective sensations after injections there is a discrepancy. The subjective sensations are found to be only slightly better. More investigations, also after repeated injections are necessary.