Intravitreal bevacizumab for treatment-naïve patients with subfoveal occult choroidal neovascularization secondary to age-related macular degeneration: A 12-month follow-up study
Department of Health Sciences, University of Molise, Campobasso, Italy. Retina (Philadelphia, Pa.)
(Impact Factor: 3.24).
10/2009; 29(9):1227-34. DOI: 10.1097/IAE.0b013e3181b773e1
The aim of this study was to assess the 12-month efficacy of intravitreal bevacizumab (IVB) injection for occult choroidal neovascularization secondary to age-related macular degeneration.
In this retrospective, interventional case series, 68 treatment-naïve patients with age-related macular degeneration, affected by subfoveal occult choroidal neovascularization showing recent disease progression, were monitored during the IVB protocol. The patients received 1 initial IVB injection (1.25 mg/0.05 mL), and they underwent further retreatment on a monthly basis only when necessary, according to a standardized as-required regimen, until no significant signs of choroidal neovascularization activity were present. Main outcome measures were the modifications in best-corrected visual acuity and in central retinal thickness measured by optical coherence tomography.
With respect to baseline, at the 12-month check, mean best-corrected visual acuity increased from 0.82 to 0.45 logMAR (P < 0.01) and mean central retinal thickness decreased from 517.0 microm to 306.5 microm (P < 0.01). To achieve these benefits, the required mean IVB number was lowered from 3.87 in the first 6 months to 1.085 in the second 6 months. A better final best-corrected visual acuity was correlated with greater best-corrected visual acuity (P < 0.005) and lesser central retinal thickness (P < 0.05) at baseline.
In patients with age-related macular degeneration complicated by progressive occult choroidal neovascularization, first-line IVB administration represents a useful therapeutic option, especially considering its lower cost in comparison with other antiangiogenic drugs.
Available from: Ciro Costagliola
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ABSTRACT: Choroidal neovascularization (CNV) is a common and severe complication in heterogeneous diseases affecting the posterior segment of the eye, the most frequent being represented by age-related macular degeneration. Although the term may suggest just a vascular pathological condition, CNV is more properly definable as an aberrant tissue invasion of endothelial and inflammatory cells, in which both angiogenesis and inflammation are involved. Experimental and clinical evidences show that vascular endothelial growth factor is a key signal in promoting angiogenesis. However, many other molecules, distinctive of the inflammatory response, act as neovascular activators in CNV. These include fibroblast growth factor, transforming growth factor, tumor necrosis factor, interleukins, and complement. This paper reviews the role of inflammatory mediators and angiogenic factors in the development of CNV, proposing pathogenetic assumptions of mutual interaction. As an extension of this concept, new therapeutic approaches geared to have an effect on both the vascular and the extravascular components of CNV are discussed.
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Available from: Ida Cesarano
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ABSTRACT: To evaluate best-corrected visual acuity (BCVA) and foveal thickness (FT) changes in occult subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) after intravitreal bevacizumab (IVB, 1.25 mg/0.05 ml), pegaptanib (IVP, 0.3 mg/0.09 ml) and triamcinolone acetonide (IVTA, 4 mg/0.1 ml) injected on an as needed basis.
Retrospective, interventional, comparative study. BCVA (Early Treatment Diabetic Retinopathy Study LogMAR) and FT by optical coherence tomography (OCT) were evaluated during 12 months from first treatment. Patients were retreated if signs of neovascular activity were still present on angiography or OCT.
Forty-eight eyes received IVB, 43 eyes received IVP, 52 eyes received IVTA. BCVA and FT at baseline were 1.22 ± 0.49 LogMAR and 410.2 ± 41.83 μm in the IVB group, 1.25 ± 0.43 LogMAR and 452.3 ± 44.83 μm in the IVP group and 1.31 ± 0.4 LogMAR and 456.6 ± 48.27 μm in the IVTA group. BCVA and FT improved in the three groups during follow-up. A significantly greater improvement of BCVA was present at month-3, month-6 and at month-12 in the IVB and IVP groups (p = 0.01). Improvement of FT was greater in the IVTA group at month-3 (p = 0.02), while it was greater in the anti-Vascular Endothelial Growth Factor (VEGF) groups at month-6 and month-12 (p = 0.01). A postoperative increase of intraocular pressure was detected in 9/52 (17.3%) eyes treated with IVTA, and in two cases it was resistant to topical therapy.
Intravitreal injection of anti-VEGF drugs administered on an as needed basis for AMD-related occult CNVs provided functional and anatomic improvement during 12 months of follow-up.
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