Inoue M, Kadonosono K, Watanabe Y, et al.. Results of 1-year follow-up examinations after intravitreal bevacizumab administration for idiopathic choroidal neovascularization

Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
Retina (Philadelphia, Pa.) (Impact Factor: 3.24). 02/2010; 30(5):733-8. DOI: 10.1097/IAE.0b013e3181c9699c
Source: PubMed


The purpose of this study was to report the results of 1-year follow-up examinations after intravitreal bevacizumab injection for the treatment of idiopathic choroidal neovascularization.
Seven eyes in 7 patients with idiopathic choroidal neovascularization were intravitreally injected with 1.25 mg/0.05 mL of bevacizumab. The need for retreatment was evaluated if spectral-domain optical coherence tomography showed intraretinal edema or subretinal fluid at the time of a 1-month follow-up examination. Fluorescein angiography was performed 1 year after the first injection. The primary outcome measures were best-corrected visual acuity and central foveal thickness using spectral-domain optical coherence tomography.
All 7 eyes were assessed at a 1-year follow-up examination. The mean number of injections per eye was 2.7. The mean logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly from 0.31 +/- 0.29 to 0.15 +/- 0.38 (P < 0.05). The mean central foveal thickness decreased from 332 +/- 83 microm to 261 +/- 66 microm (P < 0.01). Fluorescein angiography showed no leakage at 1 year in all eyes. All patients whose best-corrected visual acuity improved by > or =0.2 logarithm of the minimum angle of resolution had a visual acuity of > or =20/40 when first injected at baseline.
The intravitreal injection of bevacizumab is effective for stabilizing or improving vision in patients with idiopathic choroidal neovascularization, as evaluated at a 1-year follow-up examination. In particular, this treatment may be well tolerated in patients with a visual acuity of > or =20/40 at baseline. Additional investigations are needed to assess the long-term safety and the optimal protocol for intravitreal bevacizumab administration.

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    • "During a mean follow-up period of 4.2 months, most patients showed marked improvement in visual acuity and a decrease in central macular thickness.10 Inoue et al.,15 reported one-year follow-up of intravitreal bevacizumab in 7 subjects with ICNV, and found that treatment is effective in stabilizing or improving vision. Qi et al.,16 also reported encouraging efficacy and safety of intravitreal bevacizumab for ICNV in Chinese patients. "
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    ABSTRACT: To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization (ICNV). Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity (BCVA), presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography (OCT) or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months (range, 8 months to 20 months). Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR (P=0.031). The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 ± 146.52 and 347.16 ± 213.97 to 251.20±35.36 and 215.33 ± 43.94 μm, respectively. (P = 0.99 and P = 0.16, respectively). Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects.
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    ABSTRACT: Anti-vascular endothelial growth factor (anti-VEGF) therapies that arrest choroidal angiogenesis and reduce vascular permeability have revolutionized clinical practices for neovascular eye diseases. This review describes anti-VEGF strategies that are being evaluated in ocular diseases, other than neovascular age-related macular degeneration, in which neovascularization plays a critical role in pathogenesis. Early studies of the anti-VEGF agents, pegaptanib sodium, ranibizumab, bevacizumab, VEGF trap, and bevasiranib in the treatment of various neovascular diseases (e.g., diabetic macular edema, retinal vein occlusion, choroidal neovascularization) have shown promising results. The efficacy and safety of these agents, either alone or combined with standard treatments (e.g., laser photocoagulation), anti-inflammatory agents, or other non-VEGF-based antiangiogenic therapies, is actively investigated. Non-VEGF-driven pathways and growth factors other than VEGF may play important roles in pathogenesis and are included in certain combination therapies with VEGF inhibitors. The discovery of VEGF-A's role in the pathogenesis of neovascular ocular disease provided a strong rationale for the development of anti-VEGF-based therapies. There is now ample evidence that anti-VEGF therapies are viable treatment options for these diseases. Nevertheless, large, randomized controlled trials are still awaited to confirm early safety and efficacy findings from small, open-label prospective studies.
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    ABSTRACT: Choroidal neovascularisation (CNV) is characterised by new blood vessel growth under the retina that usually results in significant visual impairment when the fovea is involved. Though CNV is more commonly associated with age-related macular degeneration (AMD), it can occur secondary to a variety of other diseases. Recent successes with anti-angiogenic therapies suggest that they may outperform other therapies for all types of CNV. As non-AMD-related CNV cases are rare, randomised controlled trials are often not possible. This review compares the less prevalent reports of non-AMD CNV and pools evidence on the success and limitations of a variety of therapies.
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