Prognosti implications of pigment epithelial detachment in bevacizumab (avastin)-treated eyes with age-related macular degeneration and choroidal neovascularization

William R Freeman, Igor Kozak, Ritchie Martin S Yuson, Nitin Nigam, Lingyun Cheng, Francesca Mojana
Retina 2011, 31 (9): 1812-8

PURPOSE: To evaluate the response to primary bevacizumab treatment of eyes with age-related macular degeneration (AMD) and choroidal neovascularization (CNV) with a large pigment epithelial detachment (PED) component and to compare the increase in visual acuity and reabsorption of retinal fluid in PED eyes with eyes with CNV in AMD with a minimal to no PED component.

METHODS: We reviewed 43 consecutive eyes with CNV and AMD on primary bevacizumab therapy. There were 13 eyes with a large PED component in AMD with CNV and 30 eyes with a minimal to no PED in CNV. Only patients with no previous treatment for AMD and those started on purely intravitreal bevacizumab treatment were taken in the study. Pigment epithelial detachment size, time to PED collapse, and retinal or subretinal fluid resolution were determined as was Early Treatment Diabetic Retinopathy Study vision. Time to resolution of intraretinal and subretinal fluid was compared between the PED group and the non-PED group using survival analysis.

RESULTS: In AMD with CNV eyes having a large PED component, sub- and intraretinal fluid initially resolved faster than the sub-PED fluid (P = 0.03). The subretinal pigment epithelial fluid itself was highly resistant. Visual acuity improvement was similar in both groups.

CONCLUSION: Despite monthly intravitreal bevacizumab injections for neovascular AMD patients with a large component PED, the majority had minimal to no response of the PED. Sub- and intraretinal fluid response was faster in neovascular AMD without large PEDs, but after 7 months, vision change and reabsorption of intra- and subretinal fluid were similar in the two groups. Sub- and intraretinal fluid response did not appear to be related to PED size. Bevacizumab was very effective in reducing more of the sub- and intraretinal fluid than the PED fluid in AMD with CNV.

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