Ultrasound assessment of short‐term ocular vascular effects of intravitreal injection of bevacizumab (Avastin®) in neovascular age‐related macular degeneration

Abstract

Angiogenic inhibitors, alone or combined with other therapies, are believed to represent a promising treatment for neovascularization in age-related macular degeneration (wet AMD). They can maintain or improve visual acuity (VA), at least for the first 2years. However, evolution to retinal atrophy cannot be ruled out and it may be useful to assess the effects of antiangiogenic therapy on retinal and choroidal circulation. We carried out a pilot study in 15 patients with wet AMD. Time-averaged mean blood flow velocities (BFVs) in the central retinal, temporal posterior ciliary and ophthalmic arteries (CRA, TPCA and OA) were measured by ultrasound imaging before and 4weeks after a single intravitreal injection of 1.25mg bevacizumab in 0.05ml. Patients underwent two ophthalmic examinations, before and 4weeks after injection, including VA measurement and optical coherence tomography (OCT3) examination. In treated eyes, bevacizumab injection was followed by a significant improvement in VA (from 20/125 to 20/80; p=0.0214), and a decrease in mean central macular thickness (from 392±96μm to 271±50μm; p=0.0038). Mean BFV decreased by 10% in the CRA (p=0.0226), 20% in the TPCA (p=0.0026) and 20% in the OA (p=0.0003). No effect was observed in fellow eyes. Intravitreal bevacizumab acutely improved VA and reduced central macular thickness in wet AMD. Ultrasound imaging revealed that BFVs decreased in all retrobulbar arteries, suggesting that after local diffusion, bevacizumab exerts a short-term regional effect. Bevacizumab might therefore induce hypoperfusion of the whole eye, which may correspond to a vascular side-effect.