玻璃体腔注射Bevacizumab(Avastin)治疗湿性ARMD临床观察

目的:观察玻璃体腔注射bevacizumab(avastin)治疗湿性年龄相关性黄斑变性(age-related macular degeneration,ARMD)的疗效和安全性。方法:对22例22眼湿性ARMD患者行玻璃体腔注射bevacizumab1.25mg,间隔6wk再注射1次,第12wk对检查发现黄斑区水肿或渗漏明显的再注射1次。随访6mo,术后第1wk;1,3,6mo行视力、眼压、裂隙灯、间接检眼镜及光学相干断层扫描(optical coherence tomography,OCT)检查,第3,6mo行荧光素眼底血管造影(fundusfluorescence angiography,FFA)、彩色眼底照相检查,分析治疗前后患者平均视力及黄斑中心视网膜厚度(centralmacular thickness,CMT)的改变。结果:至第6mo随访,平均视力较治疗前有所提高,平均CMT比治疗前减少92.59μm,均有显著意义;FFA显示黄斑区渗漏均消失或明显减轻。除4例局部球结膜下出血,没有观察到其他不良反应。结论:玻璃体腔注射bevacizumab能够提高湿性ARMD患者的视力,减轻黄斑水肿;重复注射可以巩固疗效,减少复发。长期效果和安全性还需要更多病例和更长随访观察时间来评估。     

玻璃体腔Bevacizumab注射后联合二联术治疗新生血管性青光眼

目的：观察玻璃体腔bevacizumab注射后联合二联术治疗新生血管性青光眼( neovascular glaucoma, NVG )的临床疗效。
　　方法：NVG 患者25例25眼,行玻璃体腔内注射bevacizumab 1.0mg(0.05mL),待虹膜新生血管消退,其中5眼行前房穿刺放液辅助控制眼压,2 wk后均接受小梁切除+白内障超声乳化术(有9眼植入人工晶状体)。术后观察患者的眼压、视力、角膜、新生血管的变化及并发症,并随访12 mo。
　　结果：患者25眼注射bevacizumab后,有20眼于3~5 d虹膜新生血管消退,另有5眼于7d后虹膜新血管消退,控制眼压后,测角膜内皮细胞计数1629±226个/mm2,小梁切除+白内障超声乳化术后均未发生角膜内皮失代偿;随访12mo,20眼眼压控制在正常范围,2眼用1种抗青光眼药后眼压可控制在正常范围,3眼用抗青光眼药后眼压34~38 mmHg。9眼植入人工晶状体后,视力有提高。
　　结论：玻璃体腔注射bevacizumab可以短期有效清除虹膜和前房角新生血管,降低眼压,并减少术中、术后出血风险,联合小梁切除+白内障超声乳化术可有效治疗新生血管性青光眼。     

氟羟泼尼松龙玻璃体内注射的安全性—随机化临床验证结果

目的：确定对年龄相关性黄斑变性引起的黄斑下脉络膜新生血管形成患者行单次性玻璃体腔内注射氟羟泼尼松龙(4mg)的安全性。方法：在公众三级转诊眼科医院进行双盲随机临床试验，以安慰剂为对照。受试对象是患有年龄相关性黄斑病变并伴有典型的脉络膜新生血管形成的患者，年龄大于59岁，最佳矫正视力不低于20／200。患眼被分为氟羟泼尼松龙注射组和安慰剂注射组。注射后对受试对象每6个月检测一次眼压和白内障分级，连续3年。不良反应包括从轻微不良反应到威胁视力或威胁生命的不良反应，并被区分为注射操作相关或激素相关分别记录。     

Bevacizumab联合Ex-press引流管治疗新生血管性青光眼

目的:探讨玻璃体腔注射贝伐单抗(bevacizumab)联合Ex-press青光眼引流管植入术治疗新生血管性青光眼的疗效和安全性。方法:对18例19眼新生血管性青光眼患者,先行玻璃体腔注射bevacizumab,待虹膜新生血管消退或萎缩后,再行Ex-press青光眼引流管(P-200)植入术,其中6例6眼联合超声乳化白内障吸除术。根据患者屈光介质情况术前或术后尽量行全视网膜光凝。Ex-press植入术后随访12mo,观察视力、眼压和手术并发症情况。结果:玻璃体腔注药后2~7d,16眼新生血管全部消退。术后平均眼压:1mo:13.05±2.46mmHg,3mo:13.80±1.88mmHg,6mo:14.30±1.38mmHg;12mo:14.60±1.43mmHg,术后1,3,6,12mo眼压与术前相比均有显著性差异(P<0.05),且术后1,3,6,12mo眼压相比均无显著性差异(P>0.05)。19眼术后视力有提高者4眼,无明显改变15眼,无视力下降眼,完全成功11眼(58%),部分成功5眼(26%),总手术成功率84%(16/19)。术后并发症:有2例术后早期短暂浅前房,散瞳1wk后前房恢复正常,1例前房少量积血,无排斥反应和严重并发症。结论:玻璃体腔注射bevacizumab可使新生血管青光眼虹膜新生血管迅速消退或萎缩,为下一步青光眼手术创造良好的条件。Ex-press青光眼引流管植入术是新的滤过性手术,该手术创伤小,不用切除虹膜,减少了术中、术后出血的风险,联合bevacizumab是治疗新生血管性青光眼的安全而有效的术式。     

玻璃体腔内注射Bevacizumab治疗年龄相关性黄斑变性

目的:评估抗血管内皮生长因子单克隆抗体bevacizumab(Avastin)玻璃体腔注射治疗湿性年龄相关性黄斑变性(age-related macular degeneration,AMD)的疗效和安全性。方法:对30例接受玻璃体腔注射bevacizumab(2.5mg)治疗的AMD患者进行回顾分析,主要评价指标包括最佳矫正视力(best-corrected visual acuity,BCVA)、黄斑中心凹厚度(central foveal thickness,CFT)和黄斑容积(total macularvolume,TMV),对注射后渗漏无明显改善或病情反复者进行眼内重复注射。所有病例都完成至少6mo的观察随访。结果:患者30例30眼中男21例,女9例,平均年龄72岁。治疗前患者的基线平均对数BCVA为1.03±0.55,CFT为364.97±151.83μm,TMV为8.36±1.84mm3,注药后1wk虽然平均CFT和TMV没有显著改善,但BCVA有显著提高(logMAR,0.79±0.33;P=0.002),经平均9.7mo的随访,BCVA(logMAR,0.70±0.40;P=0.004),CFT(272.93±81.06;P=0.005)和TMV(7.20±0.98;P=0.004)3项指标均较基线有显著改善,终末随访时BCVA提高至少两行者为18眼(60%),稳定者为8眼(27%)。本组患者共接受了58次玻璃体腔内注射,平均注射次数为1.93次/眼,有50%再注射能在术后1wk使视力提高两行或两行以上。结论:玻璃体腔注射bevacizumab能够安全有效地改善或稳定多数湿性AMD的病情,但术后定期随访以及根据病情变化进行再次注射是必要的。     

PDT联合ranibizumab玻璃体腔注射治疗年龄相关性黄斑变性合并CNV

目的：观察 PDT 联合玻璃体腔注射 ranibizumab (雷珠单抗)治疗老年性黄斑变性脉络膜新生血管( choroidal neovascularization,CNV)的疗效。
　　方法：将符合纳入标准,经吲哚青绿脉络膜血管造影(indocyanine green angiography, ICGA)、光学相干断层扫描( optical coherence tomography, OCT)检查确诊为黄斑区脉络膜新生血管( CNV)患者27例27眼,经PDT治疗后3~7 d内行 ranibizumab 玻璃体腔注射。观察治疗后1,3,6 mo、末次随访时行最佳矫正视力、FFA、ICGA、OCT 检查及有无并发症发生情况。
　　结果：最佳矫正视力提高17眼(63%),最佳矫正视力稳定6眼(22%),最佳矫正视力下降4眼(15%)。27例27眼治疗前平均渗漏面积为1005.69±105.47μm,治疗后1,3mo后平均875.54±103.27,423.37±79.68μm,与治疗前比较差异有统计学意义(P<0.01),视网膜黄斑中央厚度27例27眼治疗前平均厚度为485.58±122.59μm,治疗后1,3mo后平均398.84±105.32,297.74±89.18μm,与治疗前比较差异有统计学意义(P<0.01)。
　　结论：PDT 封闭 CNV 后,联合玻璃体内腔内注射ranibizumab,有效阻断新生血管复发,减少PDT再次治疗次数和并发症,可提高治疗效果。     

OCTA在玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管中的应用

目的:利用光学相干断层扫描血管造影技术观察病理性近视脉络膜新生血管抗VEGF治疗期间的变化,探讨其在监测抗VEGF治疗过程的意义.方法:本研究纳入临床确诊病理性近视脉络膜新生血管患者30例30眼.对患眼行玻璃体腔注射10 mg/mL雷珠单抗0.05mL,治疗后每月随访病情,随访时间为6mo,每次随访均行最佳矫正视力(BCVA)、眼压、裂隙灯、前置镜眼底检查、OCTA检查.比较治疗前、治疗后1、3、6 mo患者BCVA及黄斑中心视网膜厚度(CMT).结果:所有患者平均玻璃体腔注射1.70±0.65次.治疗前平均最佳矫正视力(LogMAR)为0.96±0.17,治疗后1、3、6mo视力分别提高了0.23±0.09、0.34±0.07、0.38±0.11,差异均有统计学意义(t=5.461、8.191、8.894,P<0.05).治疗前平均CMT为281.07±13.72μm,治疗后1、3、6mo分别下降了19.73±9.02、37.62±15.41、46.15±25.16μm,差异均有统计学意义(t=12.007、13.360、9.531,P<0.05).注射后OCTA显示CNV血管网直径缩小,密度降低.结论:玻璃体腔注射雷珠单抗治疗病理性近视脉络膜新生血管疗效显著、安全性高;OCTA能无创、快速获得视网膜和脉络膜血管图像,为诊断病理性近视脉络膜新生血管和监控其治疗效果提供有力工具.     

Ahmed引流阀植入联合玻璃体腔注射Bevacizumab治疗NVG

目的：观察Ahmed引流阀植入联合玻璃体腔注射bevacizumab(贝伐珠单抗)治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。

方法：对22例22眼新生血管性青光眼患者先进行玻璃体腔注射bevacizumab 0.1mL(2.5mg),待虹膜新生血管消退后行Ahmed青光眼阀门植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症,随访6～36(平均24)mo。

结果：玻璃体腔注药后1wk内22眼虹膜新生血管均有不同程度消退,Ahmed引流阀植入术后随访22眼中仅有3眼联合使用1～3种抗青光眼药物,眼压控制在21mmHg之内,1眼因眼压失控而行睫状体光凝术(810激光),其余18眼均无需加用抗青光眼药物眼压控制在正常范围内,最后一次随访,平均眼压15.59±3.21mmHg,与术前平均眼压(45.36±8.13mmHg)相比,差异有统计学意义(P<0.05)。视力提高者9眼(41%),保持术前视力者13眼。全部病例在玻璃体腔注射bevacizumab及Ahmed引流阀植入术中术后均未观察到严重手术并发症。

结论：Ahmed引流阀植入联合玻璃体腔注射bevacizumab治疗NVG安全有效,手术成功率高,并发症少,有利于保护残留视功能。     

玻璃体腔注射bevacizumab治疗年龄相关性黄斑变性的初步临床观察

目的初步探讨玻璃体腔内注射bevacizumab（Avastin）治疗湿性年龄相关性黄斑变性（ARMD）的临床效果。方法采用单中心非随机对照临床研究方法。收集经荧光素眼底血管造影检查（FFA）、相干光断层成像术（OCT）确诊存在黄斑中心凹下脉络膜新生血管（CNV）的ARMD患者5例,患眼最佳矫正视力均〈0．1,无全身和局部手术禁忌证。患眼行bevacizumab玻璃体腔内注射术,用量为1．5mg（0．06ml）,记录手术前、后患眼的视力、眼压、FFA和OCT的检查结果。术后随访时间4～6个月。结果全部患者均未出现眼内和全身不良反应。1例患者术后第3天出现一过性眼压升高,局部给予降眼压药物治疗后症状得到控制。1例患者术后1周视力由0．1上升至0．4;4例患者术后2个月视力提高1—6行,其中3例于术后4—6个月时视力保持稳定,1例视力下降。3例患者术后1个月黄斑水肿明显改善,黄斑中心凹视网膜厚度较术前减少5．9％～41．4％,3例患者FFA显示CNV渗漏较术前减轻。结论玻璃体腔内注射bevacizumab治疗湿性ARMD安全,副作用少,可改善患者的视功能,减轻黄斑水肿,减少CNV渗漏,有望成为药物治疗ARMD的新方法,但尚需进行多中心大样本临床随机对照研究。     

OCTA评价康柏西普治疗湿性年龄相关性黄斑变性的疗效

目的：以光学相干断层扫描血管成像(optical coherence tomography angiography,OCTA)评价玻璃体腔注射康柏西普治疗湿性年龄相关性黄斑变性(wet age-related macular degeneration,wAMD)的临床疗效。

方法：收集芜湖市眼科医院2016-12/2017-11收治的18例20眼确诊为wAMD的患者,给予玻璃体腔注射康柏西普注射治疗,随访记录治疗1mo后最佳矫正视力(best corrected visual acuity,BCVA),OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness,FMT)、黄斑中心凹旁厚度(parafoveal macular thickness,PMT)、脉络膜新生血管(choroidal neovascularization,CNV)面积,以及中心凹和中心凹旁浅层血管密度。比较治疗前后各指标的变化。

结果：患者18例20眼经玻璃体腔注射康柏西普治疗1mo后,平均BCVA较术前提高,差异有统计学意义(P<0.05),平均FMT、PMT、CNV面积及中心凹浅层血流密度与治疗前相比明显下降,差异有统计学意义(P<0.05),中心凹旁浅层血流密度较术前减少,但差异无统计学意义(P>0.05)。

结论：玻璃体腔注射康柏西普治疗wAMD是安全有效的,同时发现玻璃体腔注射康柏西普能改变视网膜脉络膜自身血管结构。OCTA用于评价康柏西普治疗wAMD的临床疗效更安全,更客观。     

Retinal pigment epithelial tear after intravitreal bevacizumab injection

PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). DESIGN: Observational case series. METHODS: Two patients presented with occult choroidal neovascularization secondary to AMD. Both patients received intravitreal bevacizumab injections. RESULTS: The first patient developed a RPE tear shortly after a third intravitreal bevacizumab injection. The second patient developed a RPE tear 10 days after a second intravitreal bevacizumab injection. CONCLUSIONS: Although RPE tears may occur spontaneously as part of the natural history of exudative AMD, patients may develop visually devastating RPE tears after repeat intravitreal bevacizumab injection. Further studies are needed to determine the incidence of RPE tears after intravitreal bevacizumab injections.     

Treatment of neovascular age-related macular degeneration with intravitreal bevacizumab: efficacy of three consecutive monthly injections

PURPOSE: To report the efficacy of treatment of neovascular age-related macular degeneration (AMD) with intravitreal bevacizumab (Avastin; Genentech, Inc, South San Francisco, California, USA) when administered in a series of three monthly injections followed by a period of observation. DESIGN: Retrospective case series. METHODS: Retrospective review of consecutive eyes with all choroidal neovascular lesion subtypes resulting from neovascular AMD treated with intravitreal bevacizumab. Treatment consisted of a pars plana injection of 1.25 mg Avastin (0.05 ml bevacizumab at a concentration of 25 mg/ml). Evaluation consisted of a complete ophthalmologic examination, including best-corrected visual acuity (VA) measurement, ophthalmoscopy, and optical coherence tomography. Eyes received a series of three monthly injections followed by a three-month period of observation. RESULTS: A total of 36 patients (37 eyes) received a series of three consecutive monthly intravitreal injections of bevacizumab. Twenty (54%) of 37 eyes had no previous treatments for neovascular AMD in the eye that received bevacizumab. Seventeen (46%) of 37 eyes had received some previous treatment before initiation of bevacizumab therapy. Intravitreal Avastin therapy produced an improvement in foveal thickness over time in eyes with neovascular AMD. This improvement was sustained during the series of three monthly injections. All eyes experienced worsening after three months without treatment. No statistically significant effect on VA was demonstrated in this series. CONCLUSION: Intravitreal bevacizumab therapy produced an improvement in foveal thickness over time in eyes with neovascular AMD when one injection was given each month for three consecutive months. All eyes experienced increased foveal thickening during the subsequent three months without treatment.     

Vascular endothelial growth factor plasma levels before and after treatment of neovascular age‐related macular degeneration with bevacizumab or ranibizumab

Purpose:  To evaluate the changes of vascular endothelial growth factor (VEGF) plasma levels after intravitreal injections of ranibizumab or bevacizumab in patients with exudative age‐related macular degeneration (AMD). Methods:  Forty‐three patients with exudative AMD and 19 age‐ and sex‐matched control patients without chorioretinal diseases were studied. Nineteen patients were treated with intravitreal ranibizumab 0.5 mg, 24 with intravitreal bevacizumab 1.25 mg. Blood samples were collected just before the first injection, and 28 days after three initial consecutive injections performed in 4‐weekly intervals (loading dose). Concentration of VEGF in the plasma was measured by ELISA. Results:  At baseline, the median VEGF concentrations in controls were 180.97 pg/ml, in the bevacizumab group 189.72 pg/ml and in the ranibizumab group 191.36 pg/ml. VEGF plasma concentrations in patients with wet AMD were comparable to controls (p = 0.225). Twenty‐eight days after the third injection, a significant reduction of 42% in the median VEGF plasma levels was found in bevacizumab‐treated patients (109.97 pg/ml; p = 0.0002) but not in ranibizumab‐treated patients (189.97 pg/ml; p = 0.198) where a reduction of 0.7% in the median value was found. Conclusions:  Intravitreal bevacizumab significantly reduced VEGF plasma levels until 28 days after intravitreal injection in patients with exudative AMD. Ranibizumab did not achieve a significant plasma VEGF reduction at the same time‐point. These findings alert to the potential systemic safety differences between the two drugs after intravitreal administration.     

Retinal pigment epithelial tears after intravitreal bevacizumab injection for predominantly classic choroidal neovascularization

PURPOSE: To detect retinal pigment epithelium (RPE) tears in predominantly classic choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with intravitreal bevacizumab injections. METHODS: Forty consecutive patients with predominantly classic CNV secondary to AMD were treated with 1.25 mg of intravitreal bevacizumab. Patients were evaluated with visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study charts, optical coherence tomography, and fluorescein angiography. RESULTS: Three patients developed a RPE tear after the first injection. The first patient had been treated with verteporfin therapy and VA remained unchanged. In the other two cases the CNV was naive and VA improved since the foveal center was not involved by the tear and macular edema was reduced. CONCLUSIONS: RPE tears can occur following intravitreal bevacizumab injections in patients with predominantly classic CNV although VA is not always affected.     

Retinal pigment epithelium tear after intravitreal bevacizumab for exudative age-related macular degeneration

PURPOSE: To report on the development of retinal pigment epithelium tears after intravitreal injections of bevacizumab as treatment of exudative age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: The study included 63 patients who received an intravitreal injection of 1.5 mg bevacizumab as treatment of a detachment of the retinal pigment epithelium attributable to AMD and who had a follow-up of at least two months. RESULTS: Four patients (6%) developed a tear of the retinal pigment epithelium in the parafoveal region. Compared with the baseline value, visual acuity at the end of follow-up remained stable in three patients and declined in the fourth patient. CONCLUSIONS: Intravitreal injections of bevacizumab may be followed by a tear of the retinal pigment epithelium in eyes with exudative AMD and a retinal pigment epithelium detachment.     

Retinal pigment epithelium tears after intravitreal injection of bevacizumab (avastin) for neovascular age-related macular degeneration

BACKGROUND: Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab. METHODS: In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate. RESULTS: Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%. CONCLUSIONS: RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.     

Early effects of systemic and intravitreal bevacizumab (avastin) therapy for neovascular age-related macular degeneration

PURPOSE: The purpose of this study was to evaluate the early treatment response following systemic and intravitreal bevacizumab therapy in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: In a prospective cohort study 12 eyes with neovascular AMD were treated with 5 mg/kg systemic bevacizumab, and 13 eyes with 1 mg intravitreal bevacizumab. Systemic therapy was given three times at 2-week intervals, intravitreal therapy up to three times at 4-week intervals. Patients were evaluated according to best corrected visual acuity (VA) and optical coherence tomography (OCT) at baseline as well as at week 1, week 4 and week 12 after therapy. Fluorescein angiography (FA) was performed at baseline and week 12. RESULTS: Systemic and intravitreal bevacizumab therapy showed a treatment response within one week. Visual acuity improved at week 1 by 4.9 letters from baseline in the systemic and by 6.9 letters in the intravitreal treatment group. Central retinal thickness (CRT), as measured by OCT decreased by 51.9 microm and 176.4 microm, respectively. At month 3 a persistent treatment effect was detectable. Mean gain in visual acuity was 11 letters in the systemic and 8.3 letters in the intravitreal group, CRT had decreased by 100 microm and 153.8 microm, respectively. Leakage as evaluated by FA was significantly reduced or absent in all patients. CONCLUSION: The early treatment responses following systemic and intravitreal bevacizumab appear to be similar. Both groups show improvement in VA and decrease in CRT within 1 week and up to 3 months. Long-term follow-up is required to evaluate the safety and treatment durability of both treatment modalities using bevacizumab.     

Electrophysiologic findings after intravitreal bevacizumab (Avastin) treatment

PURPOSE: To evaluate the short-term electrophysiologic effects of intravitreal bevacizumab in the treatment of exudative age-related macular degeneration (AMD). METHODS: Nine subjects with AMD who received treatment with intravitreal bevacizumab for exudative AMD underwent pretreatment testing with multifocal electroretinography (mf-ERG) or Ganzfeld electroretinography (G-ERG). All five G-ERG subjects underwent repeated testing at 1 week after intravitreal bevacizumab. All four mf-ERG subjects and four of the five G-ERG subjects underwent repeated testing with the same pretreatment protocol at 1 month after treatment. One G-ERG subject also received a second intravitreal injection of bevacizumab at 6 weeks after initial treatment and underwent repeated testing at 1 month after the second dose (3 months after initial treatment). RESULTS: All four subjects undergoing mf-ERG had improvement of the macular response at 1 month of after treatment. The average improvement in response density of the central 15 degrees of macular response was 35% (range, 11-65%). Subjects undergoing G-ERG testing had no significant changes in electrophysiologic response, although some variation in amplitude and implicit time was noted at different testing times. Optical coherence tomography central subfield thickness decreased from 298 microm at baseline to 274 microm at 1 month after treatment. Visual acuity improved in a majority of subjects. CONCLUSION: In this study, the intravitreal use of bevacizumab resulted in improvement of mf-ERG macular function responses and relatively stable G-ERG responses. The macular electrophysiologic response suggests that macular function improves with treatment. G-ERG suggests that there is no significant measurable photoreceptor toxicity with the use of intravitreal bevacizumab over the short term.     

Intravitreal bevacizumab combined with photodynamic therapy for the treatment of occult choroidal neovascularization associated with serous pigment epithelium detachment in age-related macular degeneration

PURPOSE: To evaluate the efficacy of intravitreal injection of bevacizumab combined with photodynamic therapy (PDT) for the treatment of occult choroidal neovascularization (CNV) associated with serous pigment epithelium detachment (s-PED) due to age-related macular degeneration (AMD). METHODS: In this retrospective study, six patients (six eyes) with subfoveal occult CNV associated with s-PED due to AMD were treated with intravitreal bevacizumab combined with PDT. All patients were treated at baseline with PDT followed by intravitreal bevacizumab 1.25 mg 1 hour later. Afterwards, according to the findings of optical coherence tomography and fluorescein angiography, repeat bevacizumab injections were given, if necessary, monthly for three doses followed by further doses every 3 months. PDT was repeated every 3 months according to the same criteria. Follow-up time was 9 months. RESULTS: All patients completed their treatment during the first 3 months from baseline. Best-corrected visual acuity (BCVA) improved or remained stable related to the baseline values in all patients at the end of the follow-up time. Mean BCVA improved from 20/67 to 20/42. S-PED and subretinal fluid decreased or disappeared. The mean central 1-mm retinal thickness was reduced from baseline value for the 9-month follow-up period by 128 microm. CONCLUSION: Intravitreal bevacizumab combined with PDT seems to be a promising treatment with good functional and anatomical results for occult CNV associated with s-PED due to AMD.     

Bevacizumab and neovascular age related macular degeneration: pathogenesis and treatment

The pathogenesis of neovascular age related macular degeneration (AMD) is multifactorial including inflammation and angiogenesis leading to choroidal neovascularization (CNV). Therapy against vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular AMD. Intravitreal off-label use of bevacizumab proved to be safe. This literature review was conducted to study improvement in visual acuity, change in central retinal thickness (CRT), safety, pharmacodynamics, and possible resistance to intravitreal bevacizumab over a one-year period in eyes with neovascular AMD. We reviewed articles between 1997 and January 2010 that included at least 30 patients with AMD who received intravitreal bevacizumab monotherapy for at least 1 year. The mean number of letters gained, decrease in CRT, and number of injections were 8 letters, 125.3 μm, and 4.3 injections, respectively. Further, randomized prospective clinical trials are needed to determine the efficacy and safety of intravitreal bevacizumab in the treatment of neovascular AMD.