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International Ophthalmology

, 29:349 | Cite as

Intravitreal bevacizumab (avastin) for subfoveal neovascular age-related macular degeneration

  • Jaime Levy
  • Marina Shneck
  • Shirley Rosen
  • Itamar Klemperer
  • David Rand
  • Orly Weinstein
  • Anry Pitchkhadze
  • Nadav Belfair
  • Tova Lifshitz
Original Paper

Abstract

Objective To report the visual and anatomic outcome of intravitreal bevacizumab (Avastin) injections in the treatment of subfoveal neovascular age-related macular degeneration (AMD). Methods Interventional, consecutive, retrospective case series. Sixty-five eyes of 65 patients with subfoveal neovascular age-related macular degeneration (AMD) received three intravitreal bevacizumab (1.25 mg) injections. Outcome measures included visual acuity (VA), central retinal thickness (CRT), and size of lesion at 24 or more weeks follow-up. Results Thirty-five eyes had prior treatment with photodynamic therapy (PDT). At presentation, VA was 1.12 ± 0.62 logMAR, CRT was 305 ± 115 μm, and greatest linear diameter (GLD) of the lesion was 4,902 ± 1,861 μm. There was no statistically significant difference between previous PDT and naïve eyes in VA, CRT, and GLD at presentation. After three bevacizumab injections, VA, CRT, and GLD significantly improved (P < 0.0001 in all groups). There was no statistically significant difference between CRT and GLD outcomes and subfoveal neovascular membrane type or age. Eyes with better VA at baseline and without previous PDT treatment achieved better final VA (P < 0.0001 and P = 0.045, respectively). A classic membrane type and lower age were somewhat associated with better post-treatment VA. Conclusions Short-term results suggest that intravitreal bevacizumab is well tolerated and associated with improvement in VA, decreased CRT, and decreased lesion size in most patients. The most important predictors of final VA outcomes were baseline VA and no previous PDT treatment. Further evaluation of intravitreal bevacizumab for the treatment of subfoveal neovascular AMD is warranted.

Keywords

Intravitreal bevacizumab Avastin Choroidal neovascularization Age-related macular degeneration Prognostic factors 

Notes

Acknowledgments

The authors have no proprietary interest in any of the materials or techniques used in this study.

References

  1. 1.
    Friedman DS, O’Colmain BJ, Munoz B et al (2004) Eye diseases prevalence research group. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol 122:564–572PubMedCrossRefGoogle Scholar
  2. 2.
    Macular Photocoagulation Study Group (1982) Argon laser photocoagulation for senile macular degeneration. Results of a randomized clinical trial. Arch Ophthalmol 100:912–918Google Scholar
  3. 3.
    Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group (2001) Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: 2-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol 119:198–207Google Scholar
  4. 4.
    Lopez PF, Sippy BD, Lambert HM et al (1996) Transdifferentiated retinal pigment epithelial cells are immunoreactive for vascular endothelial growth factor in surgically excised age-related macular degeneration-related choroidal neovascular membranes. Invest Ophthalmol Vis Sci 37:855–868PubMedGoogle Scholar
  5. 5.
    Kvanta A, Algvere PV, Berglin L, Seregard S (1996) Subfoveal fibrovascular membranes in age-related macular degeneration express vascular endothelial growth factor. Invest Ophthalmol Vis Sci 37:1929–1934PubMedGoogle Scholar
  6. 6.
    Rakic JM, Lambert V, Devy L et al (2003) Placental growth factor, a member of the VEGF family, contributes to the development of choroidal neovascularization. Invest Ophthalmol Vis Sci 44:3186–3193PubMedCrossRefGoogle Scholar
  7. 7.
    Gragoudas ES, Adamis AP, Cunningham ET et al (2004) VEGF inhibition study in ocular neovascularization clinical trial group. Pegaptanib for neovascular age-related macular degeneration. N Engl J Med 351:2805–2816PubMedCrossRefGoogle Scholar
  8. 8.
    Ferrara N, Damico L, Shams N et al (2006) Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina 26:859–870PubMedCrossRefGoogle Scholar
  9. 9.
    Rosenfeld PJ, Brown DM, Heier JS et al (2006) MARINA study group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355:1419–1431PubMedCrossRefGoogle Scholar
  10. 10.
    Spaide RF, Laud K, Fine HF et al (2006) Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina 26:383–390PubMedCrossRefGoogle Scholar
  11. 11.
    Bashshur ZF, Bazarbachi A, Schakal A et al (2006) Intravitreal bevacizumab for the management of choroidal neovascularization in age-related macular degeneration. Am J Ophthalmol 142:1–9PubMedCrossRefGoogle Scholar
  12. 12.
    Aggio FB, Farah ME, Silva WC, Melo GB (2007) Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments. Graefes Arch Clin Exp Ophthalmol 245:215–220PubMedCrossRefGoogle Scholar
  13. 13.
    Rich RM, Rosenfeld PJ, Puliafito CA et al (2006) Short-term safety and efficacy of intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina 26:495–511PubMedCrossRefGoogle Scholar
  14. 14.
    Yoganathan P, Deramo VA, Lai JC et al (2006) Visual improvement following intravitreal bevacizumab (Avastin) in exudative age-related macular degeneration. Retina 26:994–998PubMedCrossRefGoogle Scholar
  15. 15.
    Avery RL, Pieramici DJ, Rabena MD et al (2006) Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 113:363–372PubMedCrossRefGoogle Scholar
  16. 16.
    Chen CY, Wong TY, Heriot WJ (2007) Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration: a short-term study. Am J Ophthalmol 143:510–512PubMedCrossRefGoogle Scholar
  17. 17.
    Emerson MV, Lauer AK, Flaxel CJ et al (2007) Intravitreal bevacizumab (Avastin) treatment of neovascular age-related macular degeneration. Retina 27:439–444PubMedCrossRefGoogle Scholar
  18. 18.
    Lazic R, Gabric N (2007) Intravitreally administered bevacizumab (Avastin) in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 245:68–73PubMedCrossRefGoogle Scholar
  19. 19.
    Pedersen R, Soliman W, Lund-Andersen H, Larsen M (2007) Treatment of choroidal neovascularization using intravitreal bevacizumab. Acta Ophthalmol Scand 85:526–533PubMedCrossRefGoogle Scholar
  20. 20.
    Jonas JB, Libondi T, Ihloff AK et al (2007) Visual acuity change after intravitreal bevacizumab for exudative age-related macular degeneration in relation to subfoveal membrane type. Acta Ophthalmol Scand 85:563–565PubMedCrossRefGoogle Scholar
  21. 21.
    Aisenbrey S, Ziemssen F, Völker M et al (2007) Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 247:941–948CrossRefGoogle Scholar
  22. 22.
    Abraham-Marin ML, Cortes-Luna CF et al (2007) Intravitreal bevacizumab therapy for neovascular age-related macular degeneration: a pilot study. Graefes Arch Clin Exp Ophthalmol 245:651–655PubMedCrossRefGoogle Scholar
  23. 23.
    Goff MJ, Johnson RN, McDonald HR et al (2007) Intravitreal bevacizumab for previously treated choroidal neovascularization from age-related macular degeneration. Retina 27:432–438PubMedCrossRefGoogle Scholar
  24. 24.
    Chen E, Kaiser RS, Vander JF (2007) Intravitreal bevacizumab for refractory pigment epithelial detachment with occult choroidal neovascularization in age-related macular degeneration. Retina 27:445–450PubMedCrossRefGoogle Scholar
  25. 25.
    Aggio FB, Farah ME, Silva WC, Melo GB (2007) Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments. Graefes Arch Clin Exp Ophthalmol 245:215–220PubMedCrossRefGoogle Scholar
  26. 26.
    Boyer DS, Antoszyk AN, Awh CC et al (2007) Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology 114:246–252PubMedCrossRefGoogle Scholar
  27. 27.
    Blinder KJ, Bradley S, Bressler NM et al (2003) Treatment of age-related macular degeneration with photodynamic therapy study group; verteporfin in photodynamic therapy study group. Effect of lesion size, visual acuity, and lesion composition on visual acuity change with and without verteporfin therapy for choroidal neovascularization secondary to age-related macular degeneration: TAP and VIP report no. 1. Am J Ophthalmol 136:407–418Google Scholar
  28. 28.
    Aggio FB, Farah ME, de Melo GB et al (2007) Acute endophthalmitis following intravitreal bevacizumab (Avastin) injection. Eye 21:408–409PubMedCrossRefGoogle Scholar
  29. 29.
    Fung AE, Rosenfeld PJ, Reichel E (2006) The International intravitreal bevacizumab safety survey: using the internet to assess drug safety worldwide. Br J Ophthalmol 90:1344–1349PubMedCrossRefGoogle Scholar
  30. 30.
    Spandau UH, Jonas JB (2006) Retinal pigment epithelium tear after intravitreal bevacizumab for exudative age-related macular degeneration. Am J Ophthalmol 142:1068–1070PubMedCrossRefGoogle Scholar
  31. 31.
    Shah CP, Hsu J, Garg SJ et al (2006) Retinal pigment epithelial tear after intravitreal bevacizumab injection. Am J Ophthalmol 142:1070–1072PubMedCrossRefGoogle Scholar
  32. 32.
    Chan CK, Meyer CH, Gross JG et al (2007) Retinal pigment epithelial tears after intravitreal bevacizumab injection for neovascular age-related macular degeneration. Retina 27:541–551PubMedCrossRefGoogle Scholar
  33. 33.
    Ronan SM, Yoganathan P, Chien FY et al (2007) Retinal pigment epithelium tears after intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration. Retina 27:535–540PubMedCrossRefGoogle Scholar
  34. 34.
    Gamulescu MA, Framme C, Sachs H (2007) RPE-rip after intravitreal bevacizumab (Avastin) treatment for vascularised PED secondary to AMD. Graefes Arch Clin Exp Ophthalmol 245:1037–1040PubMedCrossRefGoogle Scholar
  35. 35.
    Manzano RP, Peyman GA, Khan P, Kivilcim M (2006) Testing intravitreal toxicity of bevacizumab (Avastin). Retina 26:257–261PubMedCrossRefGoogle Scholar
  36. 36.
    Luthra S, Narayanan R, Marques LE et al (2006) Evaluation of in vitro effects of bevacizumab (Avastin) on retinal pigment epithelial, neurosensory retinal, and microvascular endothelial cells. Retina 26:512–518PubMedCrossRefGoogle Scholar
  37. 37.
    Bakri SJ, Cameron JD, McCannel CA et al (2006) Absence of histologic retinal toxicity of intravitreal bevacizumab in a rabbit model. Am J Ophthalmol 142:162–164PubMedCrossRefGoogle Scholar
  38. 38.
    Costa RA, Jorge R, Calucci D et al (2006) Intravitreal bevacizumab for choroidal neovascularization caused by AMD (IBeNA Study): results of a phase 1 dose-escalation study. Invest Ophthalmol Vis Sci 47:4569–4578PubMedCrossRefGoogle Scholar
  39. 39.
    Heiduschka P, Fietz H, Hofmeister S et al (2007) Tübingen bevacizumab study group. Penetration of bevacizumab through the retina after intravitreal injection in the monkey. Invest Ophthalmol Vis Sci 48:2814–2823PubMedCrossRefGoogle Scholar
  40. 40.
    Steinbrook R (2006) The price of sight-ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med 355:1409–1412PubMedCrossRefGoogle Scholar
  41. 41.
    Raftery J, Clegg A, Jones J et al (2007) Ranibizumab (lucentis) versus bevacizumab (avastin): modelling cost effectiveness. Br J Ophthalmol 91:1244–1246PubMedCrossRefGoogle Scholar
  42. 42.
    Dhalla MS, Shah GK, Blinder KJ et al (2006) Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration. Retina 26:988–993PubMedCrossRefGoogle Scholar
  43. 43.
    Lazic R, Gabric N (2007) Verteporfin therapy and intravitreal bevacizumab combined and alone in choroidal neovascularization due to age-related macular degeneration. Ophthalmology 114:1179–1185PubMedCrossRefGoogle Scholar
  44. 44.
    Costa RA, Jorge R, Calucci D et al (2007) Intravitreal bevacizumab (Avastin) in combination with verteporfin photodynamic therapy for choroidal neovascularization associated with age-related macular degeneration (IBeVe Study). Graefes Arch Clin Exp Ophthalmol 245:1273–1280PubMedCrossRefGoogle Scholar
  45. 45.
    Augustin AJ, Puls S, Offermann I (2007) Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 27:133–140PubMedCrossRefGoogle Scholar
  46. 46.
    Ahmadieh H, Taei R, Soheilian M et al. (2007) Single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration. BMC Ophthalmol 7:10Google Scholar
  47. 47.
    Spaide RF (2006) Rationale for combination therapies for choroidal neovascularization. Am J Ophthalmol 141:149–156PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Jaime Levy
    • 1
  • Marina Shneck
    • 1
  • Shirley Rosen
    • 2
  • Itamar Klemperer
    • 1
  • David Rand
    • 3
  • Orly Weinstein
    • 1
  • Anry Pitchkhadze
    • 1
  • Nadav Belfair
    • 1
  • Tova Lifshitz
    • 1
  1. 1.Department of OphthalmologySoroka University Medical Center, Ben-Gurion University of the NegevBeer-ShevaIsrael
  2. 2.The Center for Multidisciplinary Research in Aging, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael
  3. 3.University of Miami Miller School of MedicineMiamiUSA

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