Intravitreal Bevacizumab Therapy Research Articles

Paired responses to intravitreal bevacizumab in diabetic macular edema: predictors of response in the fellow eye

Factors predictive for response of diabetic macular edema (DME) to intravitreal bevacizumab (IVB) remain unclear. In this study, we assess the predictability of DME response to IVB based on the response to IVB in a previously treated fellow eye and other known pre-injection factors in (DME). Retrospective chart review was conducted on 28 patients (56 eyes) with bilateral DME who underwent bilateral IVB therapy. Responses in both eyes were measured by change in central subfield thickness (CSFT) via optic coherence tomography (OCT), and change in visual acuity. Age, lens status, and starting macular thickness were recorded. We found 21% of the reduction in CSFT after IVB on OCT in the study eye may be explained by the percentage change in CSFT in the previously treated fellow eye [CI: 0.092-0.716; p-value = 0.0141]. Also, the pre-injection CSFT predicts 14% of the response to IVB in the same eye [R² = 9.6%, p-value = 0.018]. When combined in a multi-factorial model, 33% of the change in CSFT following IVB may be explained by these two factors. Lens status, change in visual acuity, and age were not statistically significant predictors of response. In DME, the response to IVB in an eye is partially explained by the pre-injection retinal thickness in the same eye and by the response to IVB in the previously treated fellow eye. Lens status, change in visual acuity, and age were not statistically significant predictors of response in this study.

Injection frequency and response to bevacizumab monotherapy for diabetic macular oedema (BOLT Report 5)

AimsTo explore the parameters that influence injection frequency in patients treated with intravitreal bevacizumab (ivB) for diabetic macular oedema. Injection frequency was considered as a surrogate marker of persistent or...

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Central Retinal Vein Occlusion

To evaluate subfoveal choroidal thickness in patients with central retinal vein occlusion (CRVO) using enhanced depth imaging optical coherence tomography. Retrospective observational study. We measured bilateral subfoveal choroidal thickness, averaged for 100 scans, in 36 patients (mean age, 66 ± 15 years; 26 women and 10 men) with unilateral CRVO by using the enhanced depth imaging methods of the Spectralis optical coherence tomography system. Twenty-two patients were treated with intravitreal bevacizumab (1.25 mg/0.05 mL), and subfoveal choroidal thickness was measured before and after treatment. Statistical analysis was performed to compare subfoveal choroidal thickness of CRVO and fellow eyes and to compare subfoveal choroidal thickness before and after intravitreal bevacizumab. Mean subfoveal choroidal thickness measured in 36 eligible eyes of 36 patients was 257.1 ± 83.2 μm, which was significantly greater than that in fellow eyes (222.6 ± 67.8 μm; P < .01, paired t test). There was strong correlation between CRVO eyes and fellow eyes (r = 0.79, P < .01). Mean subfoveal choroidal thickness after intravitreal bevacizumab was 227.7 ± 65.1 μm, which was significantly thinner than that before intravitreal bevacizumab therapy (266.9 ± 79.0 μm; P < .01, paired t test). Subfoveal choroidal thickness of CRVO eyes was significantly greater than that of fellow eyes and decreased significantly after intravitreal bevacizumab treatment. Enhanced depth imaging optical coherence tomography can be used to evaluate choroidal involvement in CRVO and may assist noninvasive diagnosis and management of this disease.

Visual prognostic value of photopic negative response and optical coherence tomography in central retinal vein occlusion after anti-VEGF treatment

To investigate the potential of optical coherence tomography (OCT) and photopic negative response (PhNR) for predicting visual outcome after intravitreal bevacizumab in patients with macular edema secondary to central retinal vein occlusion (CRVO). Thirty-two consecutive patients with macular edema secondary to unilateral CRVO who were treated with three times of 6 weeks interval intravitreal bevacizumab were enrolled. LogMAR visual acuity (Va), OCT and PhNR were done before and 4 weeks after first and third injection. Stepwise multiple regression analysis was conducted between pre-treatment Va, central retinal thickness, b wave amplitude, PhNR amplitude, PhNR relative amplitude (affected eye/unaffected fellow eye, % presentation) and post-treatment Va at 4 weeks after the third injection. The predictive values of pre-treatment parameters for good visual outcome (0.2 ≤ LogMAR Va) were assessed using receiver-operating characteristics (ROC) analysis. In multiple regression analysis, pre-treatment Va (β = 0.615, P = 0.001) and PhNR relative amplitude (β = -0.352, P = 0.032) were correlated significantly with post-treatment Va. In ROC analysis, pre-treatment Va showed a 80 % sensitivity and 80 % specificity for predicting good visual outcome, at a cutoff value of 0.52 LogMAR. Pre-treatment PhNR relative amplitude demonstrated a 88 % sensitivity and 75 % specificity for predicting good visual outcome, at a cutoff value of 40.00 %. The PhNR relative amplitude can be a useful prognostic factor for visual outcome after intravitreal bevacizumab therapy in patient with macular edema secondary to CRVO. Patients with larger pre-treatment PhNR relative amplitude with better pre-treatment Va showed a better post-treatment visual outcome.

Bevacizumab for the management of diabetic macular edema

Diabetic retinopathy (DR) is a leading cause of vision loss in the working-age population and is relatedto 1%-5% of cases of blindness worldwide. Diabetic macular edema (DME) is the most frequent cause of DR vision loss and is an important public health problem. Recent studies have implicated vascular endothelial growth factor (VEGF) in DR and DME pathogenesis, as well as provided evidence of the benefits of anti-VEGF agents for the management of such conditions. Despite the benefits of intravitreal ranibizumab injection for the management of DME, the cost-effectiveness of intravitreal bevacizumab therapy has gained increasing interest in the scientific community. This review summarizes the studies examining bevacizumab for the management of DME, focusing on the efficacy and duration of the clinical benefits of decreasing DME and the improvement of best-corrected visual acuity (BCVA). There is strong evidence that intravitreal bevacizumab injection therapy has a good cost-effective profile in the management of DME and may be associated with laser photocoagulation; however, its clinical superiority in terms of the duration of DME regression and the improvement of BCVA compared with intravitreal ranibizumab and other intravitreal anti-VEGF therapies remains unclear and deserves further investigation.

Regression of Choroidal Metastasis of Non-small-cell Lung Cancer with Intravitreal Bevacizumab and Photodynamic Therapy

Regression of Choroidal Metastasis of Non-small-cell Lung Cancer with Intravitreal Bevacizumab and Photodynamic Therapy

Treatment of Coats’ disease with intravitreal bevacizumab

ObjectiveTo compare the efficacy of intravitreal bevacizumab plus ablative therapy with ablative therapy alone for Coats’ disease.MethodsA retrospective review of all paediatric patients who received treatment for Coats’ disease from...

Bevacizumab and Triamcinolone Acetonide for Choroidal Neovascularization Due to Age-Related Macular Degeneration Unresponsive to Antivascular Endothelial Growth Factors

To evaluate the safety and efficacy of a combined approach using an antivascular endothelial growth factor (VEGF) agent (bevacizumab) and a steroid (triamcinolone acetonide) for treating choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) unresponsive to anti-VEGF monotherapy. Retrospective case series. We analyzed 25 eyes with CNV due to AMD who received a combination of intravitreal bevacizumab (1 mg) and triamcinolone (4 mg). Results were assessed at 7 days, 1, 3, 6, 9, and 12 months by best-corrected visual acuity (BCVA) measurement, fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Retreatment with intravitreal bevacizumab or combination therapy was considered at investigator discretion at every follow-up visit. A mean BCVA improvement of 0.18 (95% CI: 0.05; 0.3) logMAR was reported between baseline and the 12-month measurement (P<0.01). An opposite trend toward progressive loss of BCVA, from 1.08 to 1.31 logMAR, had been observed in the 6 months before starting the combination therapy, in spite of regular treatment with anti-VEGFs (P<0.0001). OCT measurements showed a 139-μm (95% CI: 76; 203) decrease in mean central retinal thickness (P<0.01). On average, patients required 1.8 additional treatments. Five (20%) cases of intraocular pressure elevation were successfully treated with medications. Combination therapy with intravitreal bevacizumab and triamcinolone acetonide proved to be a safe and effective option for CNV unresponsive to anti-VEGF monotherapy. The combined treatment reversed the preoperative trend toward losing vision, and a significant anatomic improvement was seen by OCT.

Clinical Implications of Serous Retinal Detachment in Branch Retinal Vein Occlusion and Response After Primary Intravitreal Bevacizumab Injection

To evaluate the impact of macular serous retinal detachment (SRD) and its relationship to treatment outcome after primary intravitreal bevacizumab (IVB) injection in patients with branch retinal vein occlusion (BRVO) and macular edema (ME). Seventy-three patients with ME secondary to BRVO who received primary IVB (2.5 mg/0.1 mL) were included in this study. The specific ME patterns were investigated using optical coherence tomography (OCT) examination. Visual acuity (VA), central macular thickness (CMT), and macular volume at baseline; at 1, 3, and 6 months; and at final visit after primary IVB were retrospectively analyzed and compared between patients with and without SRD. SRD was found in 25 patients (34.2%). The baseline CMT was significantly thicker in patients with SRD than in those without it (648.4±200.5 μm vs. 440.3±119.6 μm, P<0.001). Six months after primary IVB injection, a greater reduction in CMT change from baseline was observed in the SRD group (412.5±227.2 μm) than in the group without SRD (118.5±175.2 μm) (P<0.001). The improvement of logarithm of the minimum angle of resolution VA was also greater in the SRD group than in the group without SRD (-0.64±0.52 and -0.28±0.62 respectively, P=0.015). Logistic regression analysis showed that the presence of SRD was an independent factor for visual improvement in BRVO (P=0.027). Patients with SRD had greater functional and morphological improvements at 6 months after primary IVB therapy. The results of this study suggest that the presence of SRD observed on OCT may be an indicator of favorable clinical response after IVB injections and that in BRVO patients with SRD, bevacizumab may be a good alternative for treatment.

Vascular endothelial growth factor genetic polymorphisms and susceptibility to age-related macular degeneration in Tunisian population

Purpose: Three VEGF SNPs (�2578) C/A, (+405) G/C and (+936) C/T were investigated in Tunisian exudative AMD patients in order to determine their association with the disease susceptibility and their influence to intravitreal bevacizumab therapy response. Methods: 145 AMD patients and 207 age-matched controls were included. 68 patients were treated with intravitreal bevacizumab. SNPs genotyping were performed using direct sequencing. The serum VEGF was assayed by ELISA (RDp=0.042 respectively). Conclusions: Our results show that VEGF genetic variants may contribute to the susceptibility to neovascular AMD in Tunisian patients.

Intravitreal bevacizumab versus low-fluence photodynamic therapy for treatment of chronic central serous chorioretinopathy

To report the effectiveness and safety of intravitreal bevacizumab injection (IVB) compared with low-fluence photodynamic therapy (L-PDT) in eyes with chronic central serous chorioretinopathy (CSC). This was a prospective comparative interventional study of 22 patients affected by chronic CSC. Patients were randomly assigned to group 1 (12 patients treated with 1.25 mg IVB) and group 2 (10 patients treated with L-PDT). In group 2, PDT with verteporfin was delivered at low fluence (300 mW/cm(2) for 83 s, 25 J/cm(2)). Follow-up visits were scheduled at 1, 3, 6, and 9 months. The improvement in visual acuity was greater in group 1 than in group 2, although the difference was not statistically significant (P = 0.59). The mean change in central point thickness over 9 months from baseline was 127 μm (SD 36) in group 1 and 114 μm (SD 42) in group 2. After the first injection, retreatments were given if recurrence was noted, with an average of 3.0 ± 1 injections in group 1 and 1.6 ± 0.6 treatments with L-PDT in group 2. The difference between retreatment in the 2 groups was not statistically significant (P = 0.45). Based on the results obtained after 9 months of follow-up, our study provides evidence that IVB may be a treatment option for chronic CSC.

Intravitreal ranibizumab and bevacizumab therapy for choroidal neovascularization in age-related macular degeneration with extensive pre-existing geographic atrophy

To report the response of choroidal neovascularization to intravitreal ranibizumab or bevacizumab treatment in the setting of age-related macular degeneration with extensive pre-existing geographic atrophy of the retinal pigment epithelium. This is a retrospective case series of 11 eyes in ten consecutive patients retrieved from a photographic database. The patients were treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration with pre-existing geographic atrophy. Patients were included if they had geographic atrophy at or adjacent to the foveal center of at least 1 disc area in size that was present before the development of choroidal neovascularization. The best corrected visual acuity and optical coherence tomography analysis of the central macular thickness were recorded for each visit. Serial injections of ranibizumab or bevacizumab were administered until there was complete resolution of subretinal fluid on optical coherence tomography. Data over the entire follow-up period were analyzed for overall visual and optical coherence tomography changes. The patients received an average of 7 ± 3 intravitreal injections over the treatment period. Seven of 11 eyes had reduced retinal thickening on optical coherence tomography. On average, the central macular thickness was reduced by 72 ± 115 µm. Six of these 7 eyes had improvement of one or more lines of vision and one had no change. The average acuity change for all patients was -0.04 ± 0.46 logMAR units, which corresponded to a gain of 0.2 ± 4.4 lines of Snellen acuity. The treatment resulted in a good anatomic response with resolution of the subretinal fluid and overall stable visual acuity. The results of this case series suggest that the use of an intravitreal anti-vascular endothelial growth factor (VEGF) agent (ranibizumab or bevacizumab) for choroidal neovascularization in age-related macular degeneration with pre-existing geographic atrophy is effective. Our results are not as striking as published results from large-scale trials of anti-vascular endothelial growth factor therapy for subfoveal choroidal neovascularization, presumably due to the limitation in the baseline visual acuity caused by the underlying geographic atrophy. The favorable anatomic response with the resolution of subretinal fluid and stable acuity were consistent with other ranibizumab and bevacizumab studies.

A 2-Year Prospective Randomized Controlled Trial of Intravitreal Bevacizumab or Laser Therapy (BOLT) in the Management of Diabetic Macular Edema

To report the 2-year outcomes of the BOLT study, a prospective randomized controlled trial evaluating intravitreous bevacizumab and modified Early Treatment Diabetic Retinopathy Study (ETDRS) macular laser therapy (MLT) in patients with persistent clinically significant macular edema (CSME). In a 2-year, single-center, randomized controlled trial, 80 patients with center-involving CSME and visual acuity of 20/40 to 20/320 were randomized to receive either bevacizumab or MLT. difference in ETDRS best-corrected visual acuity (BCVA) between arms. mean change in BCVA, proportion gaining at least 15 and at least 10 ETDRS letters, losing fewer than 15 and at least 30 letters, change in central macular thickness, ETDRS retinopathy severity, and safety outcomes. At 2 years, mean (SD) ETDRS BCVA was 64.4 (13.3) (ETDRS equivalent Snellen fraction: 20/50) in the bevacizumab arm and 54.8 (12.6) (20/80) in the MLT arm (P=.005). The bevacizumab arm gained a median of 9 ETDRS letters vs 2.5 letters for MLT (P=.005), with a mean gain of 8.6 letters for bevacizumab vs amean loss of 0.5 letters for MLT. Forty-nine percent of patients gained 10 or more letters (P=.001) and 32% gained at least 15 letters (P=.004) for bevacizumab vs 7% and 4% for MLT. Percentage who lost fewer than 15 letters in the MLT arm was 86% vs 100% for bevacizumab (P=.03). Mean reduction in central macular thickness was 146 μm in the bevacizumab arm vs 118 μm in the MLT arm. The median number of treatments over 24 months was 13 for bevacizumab and 4 for MLT. This study provides evidence supporting longer-term use of intravitreous bevacizumab for persistent center-involving CSME. Improvements in BCVA and central macular thickness seen with bevacizumab at 1 year were maintained over the second year with a mean of 4 injections. eudract.ema.europa.eu Identifier: 2007-000847-89

Comparison of different treatment intervals between bevacizumab injection and photodynamic therapy in combined therapy for age-related macular degeneration

To compare the results of combination therapy with different intervals between intravitreal bevacizumab and photodynamic therapy (PDT) with verteporfin for age-related macular degeneration. Treatment-naïve eyes (n = 184) with 12 months' follow-up were included in this retrospective case series. Eyes were classified according to the interval between bevacizumab and PDT administration: group D1, 1-day interval (n = 116); group D7, 7-day interval (n = 68). The study was conducted at two hospitals, with group D1 evaluated in one hospital and group D7 evaluated in the other. The main outcome measure was comparison of the increases in best-corrected visual acuity (BCVA) of the two groups 3 and 12 months after the initial treatment by means of analysis of covariance (ANCOVA). Group D1 gained 1.3 lines and group D7 gained 1.5 lines of BCVA at 3 months; group D1 gained 0.8 lines and group D7 gained 1.4 lines at 12 months. There was a significant difference between the groups in the increased BCVA levels at 3 months (P = 0.0450) and a trend toward significance at 12 months (P = 0.0516). ANCOVA analysis revealed that baseline BCVA, hemorrhagic pigment epithelial detachment, subretinal fluid, lesion size, and a 7-day treatment interval were significantly correlated with the increase in the BCVA at 3 months. A 7-day treatment interval might offer slightly better visual acuity gain in the short term than a 1-day interval.

Spectral-domain optical coherence tomography (SD-OCT) patterns and response to intravitreal bevacizumab therapy in macular edema associated with branch retinal vein occlusion

To evaluate the baseline spectral-domain optical coherence tomography (SD-OCT) characteristics of macular edema (ME) due to branch retinal vein occlusion (BRVO) for visual outcome after intravitreal bevacizumab injection. Fifty-nine patients treated in one eye with intravitreal bevacizumab for ME due to BRVO were retrospectively reviewed. Stepwise multiple regression analysis was used to evaluate the relative contribution of several variables, including SD-OCT characteristics such as photoreceptor inner segment/outer segment (IS/OS) integrity and external limiting membrane (ELM status), baseline best-corrected visual acuity (BCVA), and baseline central retinal thickness (CRT) with final visual outcome. Thirty-one patients (52.5 %) had disrupted photoreceptor IS/OS integrity. The mean BCVA improved significantly from 0.50 logMAR (20/63 Snellen equivalent) to 0.10 logMAR (20/25 Snellen equivalent) in the intact photoreceptor group (p = 0.000, paired t-test). However, the mean BCVA was improved in the disrupted photoreceptor group, from 1.10 logMAR (20/252 Snellen equivalent) to 0.94 logMAR (20/174 Snellen equivalent), which was not statistically significant (p = 0.177, paired t-test). ELM was disrupted in 23 patients (39.0 %). The mean BCVA improved significantly from 0.63 logMAR (20/85 Snellen equivalent) to 0.26 logMAR (20/36 Snellen equivalent) in the intact ELM group (p = 0.000, paired t-test), however, not significantly improved in the disrupted ELM group, from 1.09 logMAR (20/246 Snellen equivalent) to 1.01 logMAR (20/205 Snellen equivalent) (p = 0.563, paired t-test). The strongest individual predictor of final BCVA among patients with ME due to BRVO was the integrity of photoreceptor IS/OS layer on SD OCT (r (2) = 0.514, p = 0.000, stepwise multiple regression), but the most efficient model was the combination of the photoreceptor IS/OS integrity, ELM status, and baseline BCVA (r(2) = 0.671, p = 0.000, stepwise multiple regression). The strongest predictor of final BCVA was the status of photoreceptor IS/OS integrity (β = 0.532, p = 0.000, stepwise multiple regression), followed by ELM status (β = 0.325, p = 0.006, stepwise multiple regression), and the baseline BCVA (β = 0.238, p = 0.013, stepwise multiple regression). Our results suggest that baseline SD-OCT characteristics, the status of photoreceptor IS/OS and ELM can be helpful in predicting the final visual outcome after intravitreal bevacizumab injection in these patients.

Intravitreal bevacizumab for retinopathy of prematurity as first line or rescue therapy with focal laser treatment. A case series

Objectives: Laser therapy is effective in the treatment of severe forms of retinopathy of prematurity (ROP), and aggressive posterior ROP (APROP), but always damages the retina. We report our preliminary findings in seven premature infants with complicated ROP or APROP who were treated with intravitreal bevacizumab (IVB) as first line monotherapy or rescue therapy combined with laser treatment. Methods: We studied retrospectively seven preterm infants, who were affected by APROP (n = 4) or pre-threshold ROP (n = 3). Infants were treated with IVB (0.625 mg; Avastin®, Roche, Basel, Switzerland) monotherapy (n = 2) when they were too sick to undergo lengthy laser treatment. Results: Monotherapy IVB (n = 3 eyes) and IVB combined with laser therapy (n = 3 eyes) of APROP cases were followed by regression of the ROP and complete peripheral vascularization. The combined therapy with IVB and laser therapy of pre-threshold ROP (5 eyes) produced a regression of neovascularization and good retinal anatomical outcome. Conclusions: In our series, IVB was successful in treating ROP in a small cohort of extremely preterm infants with APROP or pre-threshold ROP, both as monotherapy or rescue treatment after laser therapy, without the development of ocular and systemic short- and long-term adverse effects.

Microperimetric changes after intravitreal bevacizumab injection for exudative age‐related macular degeneration

To evaluate the effect of intravitreal bevacizumab on macular function in the cases of exudative age-related macular degeneration (AMD). A total of 21 eyes of 21 patients with exudative AMD were included in this study. In each eye, at baseline and 1, 3 and 6 months after intravitreal bevacizumab injection, logMAR visual acuity, central 4° macular sensitivity, absolute scotoma size, fixation stability and fixation location by MP-1 microperimetry and optical coherence tomography (OCT) foveal morphologic changes were assessed. After the initial treatment phase which included three consecutive injections, the decision to re-treat was based on OCT and clinical findings. Subsequent injections could be administered at least 1 month after the previous injection period according to the OCT-guided treatment regimen. Mean retinal sensitivity within central 4° (12 points) area had increased from 3.69 ± 3.44 dB at baseline to 7.16 ± 3.27 dB at month 6. In all controls after the treatment, there was significant increase in logMAR visual acuity (p < 0.001) and MP-1 retinal sensitivity (p < 0.001). Mean absolute scotoma in test point location had decreased significantly from 12 of the 76 applied test point locations measured at baseline to five test point locations (-7 test point locations; p < 0.001) at month 6 showing statistical significance. Fixation properties had preserved in all patients 6 months after intravitreal bevacizumab treatment. Intravitreal bevacizumab therapy induced a significant increase in mean retinal sensitivity and significant decrease in mean absolute scotoma size during 6 months. The MP1 microperimetry proved to be a valuable tool in the evaluation of functional benefit of exudative AMD therapy with intravitreal bevacizumab.

Angiographic results of retinal-retinal anastomosis and retinal-choroidal anastomosis after treatments in eyes with retinal angiomatous proliferation

BackgroundThe purpose of this study was to evaluate the angiographic results of retinal-retinal anastomosis (RRA) and retinal-choroidal anastomosis (RCA) for eyes with retinal angiomatous proliferation (RAP) after treatment with intravitreal bevacizumab injections as monotherapy or intravitreal bevacizumab combined with photodynamic therapy.MethodsIn this interventional, consecutive case series, we retrospectively reviewed five naïve eyes from four patients (mean age 80 years) treated with three consecutive monthly intravitreal bevacizumab (1.25 mg/0.05 mL) injections as initial treatment, and followed up for at least 3 months. In cases with over 3 months of follow-up and having recurrence of RAP or leakage by fluorescein angiography, retreatment was performed with a single intravitreal bevacizumab injection and photodynamic therapy.ResultsIndocyanine green angiography showed RRA in three eyes with subretinal neovascularization and RCA in two eyes with choroidal neovascularization at baseline. At 3 months after baseline (month 3), neither the RRA nor RCA was occluded in any eye on indocyanine green angiography. Retreatment with intravitreal bevacizumab plus photodynamic therapy was performed in three eyes at months 3 (persistent leakage on fluorescein angiography), 6, and 7 (recurrence of RAP lesion), which achieved obvious occlusion of the RRA and RCA. Mean best-corrected visual acuity improved from 0.13 to 0.21 at month 3 (P = 0.066). No complications or systemic adverse events were noted.ConclusionAlthough intravitreal bevacizumab for RAP was effective in improving visual acuity during short-term follow-up, intravitreal bevacizumab could not achieve complete occlusion of RRA and RCA, which could lead to recurrence of a RAP lesion and exudation. Retreatment with intravitreal bevacizumab plus photodynamic therapy ultimately achieved complete occlusion of the RRA and RCA.

Choroidal neovascularization secondary to sorsby fundus dystrophy treated with intravitreal bevacizumab.

To report a case of extrafoveal choroidal neovascularization secondary to Sorsby fundus dystrophy that maintained 20/20 visual acuity over 14 months with intravitreal bevacizumab therapy. Interventional case report of as-needed treatment with intravitreal bevacizumab of a 38-year-old lady with choroidal neovascularization from Sorsby fundus dystrophy. Three injections of intravitreal bevacizumab were given over 14.5 months, maintaining visual acuity at 20/20. Intravitreal bevacizumab therapy appears to maintain vision in patients with choroidal neovascularization from Sorsby fundus dystrophy.

Analysis of Outcomes for Intravitreal Bevacizumab in the Treatment of Choroidal Neovascularization Secondary to Ocular Histoplasmosis

To assess the long-term outcomes of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to presumed ocular histoplasmosis syndrome (POHS). Retrospective, comparative case series. Interventional series of 150 eyes in 140 patients treated for subfoveal or juxtafoveal CNV secondary to POHS from January 2006 to January 2010. Intravitreal bevacizumab monotherapy or combination IVB and verteporfin photodynamic therapy (IVB/PDT). Visual acuity (VA) at 12 and 24 months was analyzed. Secondary outcome measures included the number of injections per year and treatment-free intervals. A total of 117 eyes received IVB monotherapy, and 34 eyes underwent combination IVB/PDT treatment. For all patients, the average pretreatment logarithm of minimum angle of resolution (logMAR) was 0.63 (Snellen equivalent 20/86) with a 12-month logMAR VA of 0.45 (Snellen equivalent 20/56) and a 24-month logMAR VA of 0.44 (Snellen equivalent 20/55). The mean follow-up was 21.1 months with an average of 4.24 IVB injections per year. There was no significant difference in initial VA, VA at 12 months, VA at 24 months, or number of eyes with a 3-line gain between the IVB monotherapy and IVB/PDT groups. Thirty-eight percent (39/104) of eyes gained 3 lines or more, and 81.2% (84/104) of subjects had maintained or improved their starting VA at 1 year. The proportion of subjects maintaining a 3-line gain in VA was relatively preserved at 2 years (29.8%, 17/57) and 3 years (30.3%, 10/32) follow-up. There was no increase in the proportion of subjects losing 3 lines or more over 3 years of follow-up. There is no significant difference in VA outcomes between IVB monotherapy versus IVB/PDT combination therapy. The use of IVB alone or in combination with PDT results in significant visual stabilization in the majority of patients with CNV secondary to POHS.