Intravitreal bevacizumab for myopic choroidal neovascularization: short-term and 1-year results.

PURPOSE

To report three-month and one-year safety and efficacy results of intravitreal bevacizumab injection (IVB) for active choroidal neovascularization associated with pathological myopia (mCNV).

METHODS

This retrospective interventional case series of 23 patients (23 eyes) was conducted at the medical retina center in the Leuven University Hospital Department of Ophthalmology, a referral center for macular diseases in Belgium. Charts were reviewed of all patients who received 1.25 mg IVB for active mCNV. If patients had two treated eyes, the eye with the longest follow-up was selected as the study eye. Injections were repeated as needed based on a decrease in visual acuity, an increase in central macular thickness (CMT) of >100 micromm on optical coherence tomography (OCT), the recurrence of macular edema on OCT and/or leakage on fluorescein angiography (FA). For statistical analysis, patients were divided into two groups based on length of follow up: patients in Group 1 had a follow-up of > or =12 months, while those in Group 2 had <12 months of followup. Changes in visual acuity (VA), as measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol, and CMT were analyzed, as were safety considerations such as intraocular inflammation and endophthalmitis.

RESULTS

Twenty-three eyes of 23 patients with ages ranging from 20 to 84 years (mean 57.7 years) were included. Mean best-corrected visual acuity (BCVA) at baseline for all patients (n=23) was 45 letters (Snellen equivalent: 20/120; 8 lines). At 3 months after initial treatment, the mean BCVA improved significantly (P < 0.05) to 58 letters (20/60(2); 10.5 lines). Eight patients had > or =12 months of follow-up (Group 1); 15 patients had > or =3 months of follow-up (Group 2). The mean BCVA for Group 1 improved significantly (P < 0.05) from 45 letters (20/120; 8 lines) to 60 letters (20/60; 11 lines), having received an average of 2.75 injections (range: 1-5) during this period and an average of one injection thereafter (mean follow-up after 12 months: 8 months). The mean BCVA for Group 2 improved significantly (P < 0.05) from 47 letters (20/120(2+); 8 lines) to 61 letters (20/60(1+); 11 lines), having received an average of 1.3 injections. CMT for all patients decreased from a mean of 266 mm at baseline to 201 mm at 1 month, 181 micromm at 3 months and 192 at 12 months (Group 1). Greater patient age was correlated with the need for more frequent injections. The oldest half of Group 1 (mean age 68.5 years) required an average of 3.75 injections, while the youngest half (mean age 39.5 years) required only 1.75. In Group 2, an inverse correlation between age and time between injections was observed. A total of 42 injections were administered. No peri- or postinjection ocular or systemic side effects were noted in either group.

CONCLUSION

Short-term and twelve-month results indicate that IVB is a safe and effective method to improve visual, reduce CMT and inhibit progression of mCNV.