Abstract
Purpose. To determine the effect of epiretinal membranes (ERM) on the treatment response and the number of intravitreal bevacizumab injections (IVB) in patients with neovascular age-related macular degeneration (nAMD). Methods. A retrospective chart review was performed on 63 eyes of 63 patients. The patients were divided into AMD group (n = 35) and AMD/ERM group (n = 28). Best corrected visual acuity (BCVA) and central retinal thickness (CRT), as well as the number of injections, were evaluated. Results. There was a significant improvement in BCVA at 3 months for the AMD and AMD/ERM groups (P = 0.02, P = 0.03, resp.). At 6, 12, and 18 months, BCVA did not change significantly in either of the groups compared to baseline (P > 0.05 for all). At 3, 6, 12, and 24 months, the AMD group had an improvement in BCVA (logMAR) of 0.09, 0.06, 0.06, and 0.03 versus 0.08, 0.07, 0.05, and 0.03 for the AMD/ERM group (P = 0.29, P = 0.88, P = 0.74, P = 0.85, resp.). A significant decrease in CRT occurred in both groups for all time points (P < 0.001 for all). The change in CRT was not statistically different between the two groups at all time points (P > 0.05 for all). The mean number of injections over 24 months was 8.8 in the AMD group and 9.2 in the AMD/ERM group (P = 0.76). Conclusion. During 24 months, visual and anatomical outcomes of IVB in nAMD patients were comparable with those in nAMD patients with ERM with similar injection numbers.
Highlights
Neovascular age-related macular degeneration is the leading cause of vision loss worldwide among people aged 50 years and older [1,2,3].Vascular endothelial growth factor (VEGF) plays a major role in choroidal neovascularization (CNV) secondary to nAMD characterized by angiogenesis and increased vascular permeability
The comparison of AMD treatment trials (CATT) was the first trial to provide evidence supporting the use of bevacizumab therapy in nAMD [17]
In the CATT, patients were randomly assigned to receive intravitreal ranibizumab or bevacizumab on a monthly schedule or on an as-needed treatment regimen which was largely driven by fluid on optical coherence tomography (OCT)
Summary
Vascular endothelial growth factor (VEGF) plays a major role in choroidal neovascularization (CNV) secondary to nAMD characterized by angiogenesis and increased vascular permeability. This condition leads to abnormal fluid collection within or below the retina [4,5,6]. Since the first introduction of the off-label use of intravitreal bevacizumab (IVB) for neovascular AMD in 2005, numerous studies have reported the efficacy and safety of this treatment [7]. Regarding ocular and systemic safety issues, as well as cost and patient convenience concerns, clinical trials with flexible dosing regimens have been released to allow for fewer injections of bevacizumab and ranibizumab [8,9,10]. ABC trial demonstrated that IVB was superior to standard care when administered on an as-needed treatment regimen for every six weeks after the initial loading phase of three injections [12]
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