Intravitreal bevacizumab (Avastin) for myopic choroidal neovascularization: six-month results of a prospective pilot study

Wai-Man Chan, Timothy Y Y Lai, David T L Liu, Dennis S C Lam
Ophthalmology 2007, 114 (12): 2190-6

PURPOSE: To evaluate the safety and efficacy of intravitreal bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM).

DESIGN: Prospective, consecutive, nonrandomized, interventional case series.

PARTICIPANTS: Twenty-two eyes of 22 patients with CNV secondary to PM.

METHODS: Consecutive patients with subfoveal or juxtafoveal CNV secondary to PM were recruited prospectively to receive an initial course of 3 monthly intravitreal injections of bevacizumab. Three additional monthly injections were performed in eyes with persistent CNV leakage after 3 months. Patients were followed up for 6 months, and the best-corrected visual acuity (BCVA), changes in fluorescein angiography, and optical coherence tomography (OCT) results were assessed.

MAIN OUTCOME MEASURES: Changes in BCVA, angiographic closure, and OCT central foveal thickness (CFT) at the 6-month follow-up.

RESULTS: The mean+/-standard deviation (SD) spherical equivalent refractive error of the 22 eyes was -10.3+/-3.7 D (range, -6.0D to -18.0D). All patients completed follow-up at 6 months. Twenty (90.9%) eyes had angiographic closure after 3 monthly injections of intravitreal bevacizumab, and 2 (9.1%) eyes required further treatment up to 6 months. The mean+/-SD logarithm of the minimum angle of resolution (logMAR) BCVA at baseline was 0.60+/-0.18 (Snellen equivalent, 20/80). At 1 and 6 months, the mean+/-SD logMAR BCVA improved significantly to 0.43 (Snellen equivalent, 20/53; P = 0.003) and 0.35 (Snellen equivalent, 20/45; P<0.001), respectively. The mean lines of improvements at 1 and 6 month compared with baseline were 1.7 and 2.6 lines, respectively. Fifteen (68.2%) eyes had an improvement of 2 or more lines at 6 months. The OCT results also showed significant reduction in CFT after treatment. No ocular or systemic complications were noted after intravitreal injections.

CONCLUSIONS: The 6-month outcomes suggest intravitreal bevacizumab to be a promising treatment method for CNV secondary to PM, resulting in both visual and anatomic improvements. Treatment resulted in complete absence of angiographic leakage in 90.9% of eyes at 3 months. Further studies to evaluate the safety, efficacy, and optimal treatment regimen are justified.

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