Bevacizumab For Myopic Choroidal Neovascularization Research Articles

Ten-Year Outcomes of Intravitreal Bevacizumab for Myopic Choroidal Neovascularization: Analysis of Prognostic Factors.

The current standard treatment of myopic choroidal neovascularisation (mCNV) is intravitreal injection of VEGF antagonists. This study was proposed to assess efficacy and safety of intravitreal bevacizumab (IVB) for the treatment of mCNV across a 10-year follow-up. Thirty eyes of thirty patients with treatment-naïve mCNV who underwent IVB and were followed up with for a minimum of ten years were recruited for the present retrospective cohort study. All participants were treated with three monthly IVB at baseline and then evaluated and treated under pro re nata (PRN) schedule. Outcome measures were to determine BCVA changes over years and identify the predictive factors of both final visual outcome and need for retreatment. Analysis of the main involved prognostic factors with correlations among variables is reported. Visual acuity remained stable at 10-year follow-up (p = 0.001) with the greatest improvement at 2 years (p < 0.0001) in all CNV locations. Baseline BCVA correlated positively with final BCVA (β = 0.88, p < 0.0001, R2: 0.75). No predictive factors for the need of additional injections were identified. Retinal and choroidal thickness significantly reduced over time but without correlation with the number of injections. CNV max height and area significantly decreased at 10 years (p < 0.0001 and p = 0.003, respectively), with complete regression of mCNV lesion in 40% of subjects. Intravitreal bevacizumab resulted as long-term effective and safe therapy for mCNV with sustained results at 10 years.

FACTORS INFLUENCING NEED FOR RETREATMENT AND LONG-TERM VISUAL OUTCOME AFTER INTRAVITREAL BEVACIZUMAB FOR MYOPIC CHOROIDAL NEOVASCULARIZATION.

To evaluate the efficacy and the predictive factors associated with the need for retreatment and long-term visual outcome after intravitreal bevacizumab for myopic choroidal neovascularization (CNV). Retrospective cohort study of 93 eyes with subfoveal or juxtafoveal myopic CNV treated initially with either 3-monthly or single intravitreal bevacizumab injections followed by pro re nata retreatment. The efficacy was evaluated by the best-corrected visual acuity (BCVA) during follow-up visits. Backward stepwise multiple linear regression analyses were performed to evaluate the potential predictive factors on final BCVA, change in BCVA, and number of injections. Multiple logistic regression was performed to evaluate the potential predictive factors for retreatment. The mean follow-up duration was 25.12 ± 11.18 (SD) months. The mean logMAR BCVA at baseline was 0.72 ± 0.58 logMAR (20/100 Snellen equivalent) and was maintained at 0.39 ± 0.46 logMAR (20/50 Snellen equivalent) at the last follow-up (P < 0.001). The mean number of injections was 3.53 ± 1.70 (range, 3-10), and a total of 25 eyes (26.9%) received retreatment. Patients who received single loading injection had significantly lower mean total number of injections (1.50 ± 0.73 vs. 3.96 ± 1.53). Both subfoveal and juxtafoveal myopic CNV eyes had significant improvement in BCVA (0.28 ± 0.43 vs. 0.22 ± 0.32 [20/40 vs 20/30 Snellen equivalent], P = 0.506), and juxtafoveal myopic CNV eyes had significantly better BCVA at baseline and at the last follow-up than the subfoveal group. Treatment-naive eyes had significant improvement from baseline BCVA, and the amount of improvement was significantly more than those who received previous photodynamic therapy (0.31 ± 0.43 vs. 0.06 ± 0.11 [20/40 vs 20/25 Snellen equivalent], P < 0.001). Multivariate stepwise regression analysis showed that the baseline CNV size (P < 0.05), baseline BCVA (P < 0.001), and duration of symptoms (P < 0.05) were significant predictive factors for final BCVA, and BCVA improvement. Multiple logistic regression analysis identified that CNV size (P = 0.014) and follow-up duration (P = 0.017) were significant predictive factors for retreatment. No significant association was found for number of injections. Intravitreal bevacizumab seems to be an effective treatment for both subfoveal and juxtafoveal myopic CNV in the long term. Patients presented with shorter duration of symptoms and smaller CNV size before treatment as significant prognostic factors that predict better visual outcome. Eyes with longer follow-up duration and larger baseline CNV size may have higher risk for retreatment.

Letter to the editor: Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization

Letter to the editor: Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization

Forty-two-month outcome of intravitreal bevacizumab in myopic choroidal neovascularization.

To evaluate the long-term efficacy of bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to pathological myopia. In this retrospective single-center non-comparative study the medical records of 29 eyes from 29 patients with naïve CNV secondary to high myopia and at least 42 months of follow up were reviewed. All eyes received a loading dose of one intravitreal injection per month for two consecutive months and were retreated on an as-needed basis during the course of follow up. The main outcome measures were post-treatment ETDRS best-corrected visual acuity (BCVA) and visual stabilization over time. Stepwise linear regression analysis was performed to identify prognostic factors for visual acuity gain and final visual acuity outcome at 42 months. At 42 months of follow-up bevacizumab was associated with the maintenance of significant benefits in visual acuity compared to baseline. No adverse ocular or systemic effects from treatment were encountered. No statistically significant correlations were found between BCVA change and any of the quantitative variables. However, when final BCVA was taken as a dependent variable and CNV size and pre-treatment VA were included as predictors, a bivariate model was identified by stepwise regression which gave a 75 % of explained variance. Bevacizumab treatment was found to be efficacious in the treatment of myopic CNV, resulting in stable gains in visual acuity lasting at least 42 months, without any adverse ocular or general events. Myopic CNV size was identified as a significant prognostic factor.

Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study

BackgroundTo compare the long-term efficacy of ranibizumab versus bevacizumab for myopic choroidal neovascularization (CNV).MethodsThis was a retrospective, multicenter, comparative, non-randomized study of 64 consecutive patients with myopic CNV treated with ranibizumab (22 patients) or bevacizumab (42 patients). Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography were evaluated before and after treatment. All the patients were followed for at least 12 months.ResultsBCVA (logarithm of the minimal angle of resolution) improved from 0.63 ± 0.30 to 0.43 ± 0.27, 0.41 ± 0.37, 0.40 ± 0.39, 0.39 ± 0.43, and 0.39 ± 0.42 at 1, 2, 3, 6, and 12 months after treatment in the ranibizumab group, and from 0.67 ± 0.28 to 0.52 ± 0.31, 0.49 ± 0.31, 0.47 ± 0.31, 0.42 ± 0.32, and 0.46 ± 0.43 in the bevacizumab group (all P < 0.05 compared with baseline BCVA in each group). CFT decreased by 20.21%, 19.58%, and 22.43% from the baseline 304 ± 76 μm at 3, 6, and 12 months after treatment in the former group, and by 15.20%, 15.67%, and 15.56% from the baseline 297 ± 62 μm in the latter group (all P < 0.05 compared with baseline CFT in each group). BCVA improvement and CFT reduction did not statistically differ when compared at the same periods from treatment between 2 groups. Neither ocular nor systemic safety problems appeared during follow up.ConclusionsThis study showed a similar functional and anatomical improvement after treatment of ranibizumab and bevacizumab for myopic CNV over a 12-month follow-up period.

Factors associated with enlargement of chorioretinal atrophy after intravitreal bevacizumab for myopic choroidal neovascularization

To determine the factors significantly associated with an enlargement of the area of a chorioretinal atrophy (ChRA) after intravitreal bevacizumab (IVB) to treat myopic choroidal neovascularization (mCNV). The medical charts of 27 eyes with a mCNV that had received IVB were reviewed. The ophthalmic examinations included measurements of the best-corrected visual acuity, visual fields with the Humphrey 10-2 Field Analyzer, fluorescein angiography, and indocyanine green angiography. The area of the mCNV and the chorioretinal atrophy (ChRA) were measured on the FA images. Eyes with an enlargement of the ChRA had significantly larger mCNVs at the baseline, a greater reduction in the size of the mCNV, a higher incidence of subretinal hemorrhage, longer duration of follow-up, received more injections of IVB, and had a greater decrease of retinal sensitivity (P ≤ 0.041). Multiple regression analyses showed that the factors most significantly associated with an enlargement of the ChRA were the CNV size at baseline, the number of IVB injections, and the duration of the follow-up period (P < 0.0001). Our findings showed that eyes with a larger CNV at the baseline and longer follow-up period had a greater risk of developing a ChRA like non-treatment, even if IVB treatment was performed for mCNV.

Comparison between One Injection and Three Monthly Injections of Intravitreal Bevacizumab for Myopic Choroidal Neovascularization

Aim: To compare the effects of one intravitreal bevacizumab (IVB) injection with three monthly injections for myopic choroidal neovascularization. Methods: Group A included 13 patients treated with one IVB injection; group B included 19 patients treated with three monthly 1.25-mg IVB injections. All patients were followed monthly for 12 months with additional injections performed as needed. The best-corrected visual acuity (BCVA) and the central foveal thickness (CFT) on optical coherence tomography were evaluated before and after treatment. Results: The mean logMAR BCVA improved from 0.59 to 0.49 at 12 months in group A (p = 0.21) and from 0.65 to 0.29 in group B (p < 0.001); the improved logMAR BCVA differed significantly between the groups (p < 0.05). The mean CFT decreased from 231 µm at baseline to 150 µm at 12 months in group A (p < 0.05) and from 279 to 156 µm in group B (p < 0.001). During the follow-up, 6 of 13 eyes in group A and 5 of 19 eyes in group B received additional injections. Conclusions: Treatment starting with three monthly IVB injections may achieve better functional outcomes with fewer retreatments compared with treatment starting with one IVB injection.

Macular detachment after successful intravitreal bevacizumab for myopic choroidal neovascularization

To determine the incidence and features of macular retinal detachment (RD) after successful intravitreal injection of bevacizumab (IVB) for the treatment of myopic choroidal neovascularizations (CNVs). Seventy-four eyes of 74 patients who received IVB for myopic CNV were studied. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed at baseline, at 1 week after IVB, and every month thereafter. The shortest follow-up period was 6 months. Four eyes (5.4%) either developed or had increased macular RD after successful IVB. In the three eyes, macular RD newly developed 1 month after IVB despite the absence of dye leakage. The remaining eye had a limited area of macular RD at baseline and increased despite the disappearance of dye leakage from the CNV after the IVB. The four eyes that developed a macular RD had retinoschisis around the CNV before IVB, whereas none of the 70 other patients had a retinoschisis throughout the follow-up period. In all four eyes that either developed or had increased macular RD, outer lamellar holes were detected at the upper edge of the RD by OCT examinations, whereas none of the patients who did not develop a macular RD after IVB showed outer lamellar holes. These results suggest that there is a risk of developing macular RD after IVB in eyes with myopic CNV. Periodic OCT examinations are recommended for patients with myopic CNV to search for RDs after IVB.

COMBINED THERAPY

The purpose of this study was to evaluate whether combined customized photodynamic therapy (PDT) and bevacizumab in myopic choroidal neovascularization can improve vision and whether it is possible to decrease the frequency and number of intravitreal antiangiogenic injections. A prospective, consecutive, noncomparative, interventional case series of 36 patients with myopic choroidal neovascularization, treated with an initial dose of PDT and intravitreal bevacizumab 48 hours to 60 hours afterward. Retreatments were carried out as required with monthly bevacizumab and PDT every 3 months if there were relapses. Follow-up lasted 1 year in all cases. The mean best-corrected visual acuity increased from 44 letters before the initial treatment to 59.5 letters at the 12-month follow-up (P < 0.01). Compared with initial vision, 94.5% of the eyes had the same or better vision and 5.5% lost fewer than 6 lines of vision. The mean number of PDT treatments was 1.1 per patient, and the mean number of bevacizumab injections was 1.5 per patient. Only 1 initial treatment with PDT + bevacizumab was necessary in 28 cases (77.8%). Combined personalized PDT + bevacizumab therapy makes it possible to obtain visual results similar to those obtained in monotherapy studies but with fewer intravitreal injections. It appears to be an interesting option for this type of patient.

Prognostic factors for visual outcomes 2-years after intravitreal bevacizumab for myopic choroidal neovascularization

To determine the pre-treatment ocular factors significantly associated with the visual outcome 24 months after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). A total of 23 eyes of 23 patients with mCNV were treated with IVB followed by as needed therapy. The efficacy of IVB was evaluated by the best-corrected visual acuity (BCVA) at 24 months after the initial treatment. Forward stepwise multiple linear regression analyses were performed to evaluate the influence of pre-treatment factors on the BCVA and the improvement of the BCVA at 24 months. The mean pre-IVB BCVA was 0.74 ± 0.30 logarithm of the minimum angle of resolution (logMAR) units, and it improved to 0.43 ± 0.31 logMAR units after 1 month (P < 0.001, paired t-test). The improvement was maintained at 24 months (0.46 ± 0.40, P < 0.005). The mean number of IVB performed during the 24 months was 1.35 ± 0.71. Forward stepwise regression analysis showed that the pre-IVB CNV size (standardized β = 0.52, P < 0.01) and BCVA (standardized β = -0.44, P < 0.05) significantly affected the visual acuity change after 24 months. The CNV size was the only factor that significantly affected the BCVA after 24 months (standardized β=0.56, P < 0.01). IVB with as needed therapy for mCNV led to a rapid and sustained visual improvement. Smaller CNV size was a significant prognostic factor that predicts better visual acuity. Patients with lower pre-treatment BCVA had better visual recovery than those with better pre-treatment BCVA, however, this may be due to a ceiling/floor effect.

Influence of age on visual results of intravitreal bevacizumab for myopic choroidal neovascularization

Abstract Purpose To evaluate the influence of age on the visual and anatomic outcome of myopic patients with choroidal neovascularization (CNV) treated with intravitreal bevacizumab (IVB). Methods Review of retrospectively collected data of 52 eyes in 50 patients with myopic CNV treated with IVB injections (1.25 mg/ 0.05ml). According to the age at onset of CNV, patients were divided into 2 groups: A younger group (&lt; 50 years); (n=25, 27 eyes) and an older group (≥ 50 years); (n=25, 25 eyes). Best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured with optical coherence tomography (OCT) were compared between the two groups over 12 months. Results The mean number of IVB injections was 1.8 in the younger group and 2.0 in the older group. In the younger group, mean BCVA improved from 1.32 logMAR at baseline to 0.77 logMAR at 12 months (p=.002). In the older group, BCVA improved from 1.0 logMAR to 0.84 logMAR at 12 moths (p=.035). There was a mean of 5.1 lines improvement in BCVA from baseline in the younger group versus a mean of 2.2 lines improvement in the older group (p&lt;.05). Decrease in mean CRT was significantly higher in the younger group than in the older one at 12 months: 114.02µm and 68.8µm respectively (p=.003). Conclusion Visual prognosis of myopic CNV treated with IVB seems to be better in patients younger than 50 years.

MACULAR FUNCTIONAL CHANGES EVALUATED WITH MP-1 MICROPERIMETRY AFTER INTRAVITREAL BEVACIZUMAB FOR SUBFOVEAL MYOPIC CHOROIDAL NEOVASCULARIZATION

The purpose of this study was to evaluate 1-year functional and structural effects of intravitreal bevacizumab for subfoveal choroidal neovascularization secondary to pathologic myopia (myopic choroidal neovascularization). Fifteen eyes with myopic choroidal neovascularization participated in this prospective interventional, noncomparative case series. All patients were treated with one intravitreal injection of 1.25 mg bevacizumab. Retreatments were performed in case of persistent or recurrent leakage on fluorescein angiography and/or intraretinal fluid on optical coherence tomography. Evaluation of best-corrected visual acuity using Early Treatment of Diabetic Retinopathy Study criteria, MP-1 microperimetry, optical coherence tomography, and fluorescein angiography were performed before treatment and 1 month, 3 months, 6 months, and 1 year after treatment. After a follow-up of 12 months, best-corrected visual acuity improved on average of 0.23 logarithm of the minimum angle of resolution. Mean macular sensitivity within the central 8 degrees increased on average of 2.62 dB at 12-month postinjection. The mean number of measurement points within the central absolute scotoma reduced significantly from 12.47 before treatment to 6.27 at 1-year follow-up. An improvement of fixation stability from baseline was observed in 9 patients (60%). No treatment adverse events were evidenced. Improvement of macular sensitivity and fixation stability 1 year after intravitreal bevacizumab for myopic choroidal neovascularization suggest a stable and progressive macular function recovery. The mean treatment session was 1.53, with 53.3% of patients needing only a single intravitreal bevacizumab injection, supporting a potential long-lasting efficacy of intravitreal bevacizumab treatment.

Two-Year Visual Results for Older Asian Women Treated With Photodynamic Therapy or Bevacizumab for Myopic Choroidal Neovascularization

To compare the long-term visual and anatomic outcome of treatment with photodynamic therapy (PDT) or intravitreal bevacizumab (IVB; Avastin; Genentech Inc, South San Francisco, California, USA) for choroidal neovascularization attributable to pathologic myopia (mCNV). An open-label, interventional case series. Multi-institutional. Thirty-one eyes of Japanese women who received either PDT or IVB for mCNV. Inclusion criteria were age 50 years or older, greatest linear dimension (GLD) 1200 to 3000 microm, and baseline best-corrected visual acuity (BCVA) 20/200 to 20/40. INTERVENTION PROCEDURES: Patients received either PDT or IVB (1 mg/40 microL) throughout the study, with re-treatment when necessary. BCVA and visual gain/loss at 3, 6, 12, 18, and 24 months after the initial treatment. Age, BCVA, location of CNV, refractive error, and symptom duration at baseline did not differ significantly between groups. BCVA was significantly improved at 3 to 12 months (P < .05); however, the significance was lost at 18 and 24 months in the IVB group. The PDT group showed no significant improvement within the first year, and vision slowly worsened after 12 months, becoming significantly worse at 18 and 24 months compared to baseline (P< .01). BCVA was significantly higher in the IVB group at 6 months (P< .05), and 12 months or further (P < .01). Visual gain was significantly greater in the IVB group at 6, 12, 18, and 24 months (P < .05 for 6, 18, and 24 months and P < .01 for 12 months). These findings indicate that the effects of PDT and IVB have a different time course, and that IVB provides a significantly better BCVA than PDT for mCNV over the long-term.

Marginal crack after intravitreal bevacizumab for myopic choroidal neovascularization

To report new indocyanine green angiographic (ICGA) findings after intravitreal bevacizumab (IVB) for myopic choroidal neovascularization (mCNV). Three eyes of three patients with mCNV were examined with fluorescein angiography (FA) and ICGA using Heidelberg Retinal Angiograph 2 and the conventional fundus camera before and after IVB. The cessation of angiographic leakage on FA was achieved in all eyes (100%) after IVB, however the hypofluorescent line delineating the margin of the neovascular tissue appeared in ICGA seemingly according to the contraction of mCNV. It was not detected either on FA or ICGA with the conventional camera. This hypofluorescence line enlarged over the time. The contraction-associated hypofluorescence line, namely marginal crack line, indicates the early damage of retinal pigment epithelium and seems to lead to expanding macular chorioretinal atrophy typically seen in mCNV.

Central Retinal Sensitivity After Intravitreal Injection of Bevacizumab for Myopic Choroidal Neovascularization

To evaluate retinal sensitivity in the macular area after intravitreal injection of bevacizumab in eyes with myopic choroidal neovascularization (mCNV). Prospective interventional case series. Twenty-two eyes of 21 patients with mCNV were treated with intravitreal injections of bevacizumab. Microperimetry in the macular area was performed with a Micro Perimeter-1 (Nidek, Vigonza, Italy) before, and at 1 month and 6 months after treatment. After treatment, visual acuity (VA) and central retinal sensitivity were improved significantly. Mean VA in logarithm of the minimal angle of resolution (logMAR) fashion improved from 0.67 +/- 0.34 to 0.43 +/- 0.33 at 1 month, and to 0.34 +/- 0.26 at 6 months [P < .01, respectively]. Mean retinal sensitivity within the central 10 degree field improved from 4.8 +/- 2.8 decibels (dB) to 6.5 +/- 3.2 dB at 1 month and to 7.4 +/- 4.4 dB at 6 months [P < .01, respectively]. These improvements were more prominent in eyes with juxtafoveal mCNV than in eyes with subfoveal mCNV. With treatment, the mean number of measurement points within the scotomas decreased significantly; the absolute scotoma was reduced substantially in 15 (68%) eyes at 6 months. Unfortunately, the absolute scotoma was significantly enlarged in 1 eye (5%) at 1 month and in 4 eyes (18%) at 6 months. Also at 6 months, chorioretinal atrophy had developed in the macular area in 4 eyes (18%). Although intravitreal injection of bevacizumab improved retinal sensitivity in the macular area, some eyes showed enlargement of the scotoma after this treatment.

Intravitreal bevacizumab on myopic choroidal neovascularization that was refractory to or had recurred after photodynamic therapy

To examine the effect of intravitreal injections of bevacizumab for myopic choroidal neovascularization (myopic CNV) that was refractory to or recurred after photodynamic therapy (PDT). Sixteen eyes of 16 consecutive patients with myopic CNVs that were refractory to or had recurred after PDT were studied. The patients were divided into two groups; group 1 consisted of six patients whose CNV recurred after being closed by PDT, and group 2 consisted of ten patients whose CNV did not respond to an earlier treatment. All of the eyes were injected intravitreally with 1.25 mg bevacizumab. The best-corrected visual acuity (BCVA) and fluorescein angiograms (FA) were assessed in both groups. The mean follow-up period was 15.1 +/- 3.6 months. Patients received a mean of 1.8 +/- 0.8 injections. The mean BCVA in the 16 patients at the final visit was significantly improved over that before the injection. Dye leakage had disappeared in 83.3% of group 1, and in all of the eyes of group 2 at the final visit. Intravitreal bevacizumab is effective for myopic CNVs that were either refractory to PDT or had recurred after being regressed by PDT.

Intravitreal injection of bevacizumab for myopic choroidal neovascularization: 1-year follow-up

To evaluate the safety and efficacy of intravitreal bevacizumab in Chinese patients with choroidal neovascularization (CNV) secondary to pathologic myopia. Eight eyes of consecutive patients with myopic CNV without earlier treatment were treated with intravitreal injection of bevacizumab (2.5 mg). All patients underwent a clinical examination, which included visual acuity measurements, fundus photography, fluorescein angiography, and optical coherence tomography. Eight eyes of eight patients with ages ranging from 26 to 62 years (mean 41.5 years) were enroled. The follow-up period ranged from 13 to 17 months (mean, 14.9 months). At the 12-month follow-up, vision had improved in all eyes by three or more lines. However, a new-onset CNV adjacent to the earlier lesion and visual loss of one line at the 16th month were observed in one eye. The mean VA had significantly improved from the baseline value 20/82 to 20/25 (P=0.017). The final mean central retinal thickness was 214.1+/-36.3 microm, with a mean decrease of 59.8 mum from the pre-treatment value (P=0.017). The mean number of injections was 1.4 (ranging from 1 to 2) within 12 months. No other ocular or systemic side effects were noted. In this small series of patients with 1-year follow-up, intravitreal injection of 2.5 mg bevacizumab seems to be effective and safe in patients with myopic CNV.

Intravitreal Bevacizumab Treatment for Choroidal Neovascularization in Pathologic Myopia: 12-month Results

To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). Prospective, nonrandomized, interventional case series. Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this prospective nonrandomized interventional case series. All patients were scheduled for three monthly intravitreal bevacizumab 1.25 mg injections. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 12 months. The mean BCVA (+/- standard deviation [SD]) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 12 months after treatment, the mean BCVA (+/- SD) improved significantly (P = .000001) to 43 (+/- 12.38) letters (Snellen equivalent: 20/35). At 12 month follow-up, BCVA improved 10 letters or more in 18 (90%) out of 20 treated eyes and improved 15 letters or more in 14 (70%) out of 20 treated eyes. No treated eyes experienced a worsening of BCVA from baseline. The mean FCT (+/- SD) at baseline was 223 (+/- 47.43) microns. At 12 months after treatment, the mean FCT (+/- SD) reduced to 206 (+/- 50.87) microns. This reduction in FCT after treatment was not statistically significant (P = .11). At 12 months follow-up, absence of fluorescein leakage from the CNV was demonstrated in 19 (95%) out of 20 treated eyes and persistent leakage in one eye (5%). None of the 19 eyes that had CNV closure experienced recurrence at 12-month follow-up. No ocular or systemic adverse effects from treatment were encountered. These results of intravitreal bevacizumab in myopic CNV are very promising with no apparent short-term safety concerns. At 12 months, treated eyes had a significant improvement in visual acuity (VA). OCT findings, as well, showed a trend consistent with the beneficial changes observed for VA. Treatment resulted in complete absence of angiographic leakage in 95% of eyes. Further studies will be needed to better determine long-term efficacy and safety.

Intravitreal Bevacizumab (Avastin) as Primary Treatment for Myopic Choroidal Neovascularization

To evaluate the short-term efficacy and safety of intravitreal bevacizumab in myopic choroidal neovascularization (mCNV). In this noncomparative, consecutive, interventional case series, 12 eyes of 11 patients with mCNV without any previous treatment were included. Patients received intravitreal bevacizumab (1.25 mg/0.05 mL) at baseline and at 4 weeks interval, if optical coherence tomography (OCT) showed presence of intraretinal edema, subretinal fluid, and/or pigment epithelial detachment. Patients were followed up for a minimum of 6 months and changes in best-corrected visual acuity, central macular thickness (CMT) on OCT, angiographic characteristics, and complications were assessed. The mean refractive error was -11.25 diopters. At 6 months the mean best-corrected visual acuity (BCVA) improved from 20/235 (median 20/235) to 20/71 (median 20/80) (p=0.01). The mean CMT was reduced from 403 microm (median 365 microm) to 229 microm (median 239 microm) (p=0.002). At final visit 9 eyes (75%) had an improvement of BCVA of three lines or more, and only 1 eye (8%) lost two lines. No significant ocular or untoward systemic side effects were observed. In this small series short-term results suggest that intravitreal bevacizumab (1.25 mg/0.05 mL) is safe, effective, and well tolerated in patients with choroidal neovascularization due to high myopia. Further evaluation in large series with longer follow-up is needed to confirm long-term efficacy and safety in such cases.