Bevacizumab (Avastin) treatment in patients with retinal angiomatous proliferation

Aim To determine the anatomical and functional outcome after injection of bevacizumab (Avastin, Genentech) in eyes with retinal angiomatous proliferation (RAP). Design Prospective interventional case series. Methods Sixteen eyes of 16 consecutive patients with visual loss due to RAP underwent intravitreal injections of 1.25 mg (0.05 ml) bevacizumab. Best corrected visual acuity testing, fluorescein and ICG-angiography as well as OCT imaging were performed at baseline and at each follow-up visit within a 3-month period. Results Mean visual acuity pre-injection was 0.68 ± 0.36 logMAR (n = 16), mean reading ability 0.58 ± 0.26 logRAD (n = 11). Far vision increased significantly by a mean of 1.7 ± 2 lines 4 weeks after the injection (p = 0.004), as did reading (0.6 ± 2.3 lines, p > 0.05). Both remained stable up to 3 months. Central retinal thickness decreased from 367 ± 112 μm (mean±SD) to 272 ± 123 μm 3 months after injection (p = 0.006). Leakage decreased angiographically in 12 eyes (75%) and remained stable in four eyes (25%). Re-injection of bevacizumab within the 3-month follow-up period was performed once in eight eyes, and twice in one eye. No adverse events were observed. Conclusion Intravitreal bevacizumab (Avastin) resulted in a reduction of leakage, intra- and subretinal fluid. An increase in visual acuity was seen already 4 weeks after first injection. However, a complete occlusion of feeder vessels could not be achieved within this 3-month period. Randomized clinical trials would be required to evaluate dose and frequency of injections and possible beneficial effects of combination therapies, as well as the long-term results.