Michael M. Lai, MD, PhD (Royal Oak, MI), Tamer F. Eliwa, MD (Royal Oak, MI), Antonio Capone, MD (Royal Oak, MI), Tarek S. Hassan, MD (Royal Oak, MI), Kimberly A. Drenser, MD (Royal Oak, MI)

PURPOSE:

To evaluate the anatomic and visual outcomes of intravitreal bevacizumab in patients with neovascular age-related macular degeneration (AMD), diabetic macular edema, and macular edema secondary to retinal vein occlusion unresponsive to conventional treatment modalities.

METHODS:

Medical records of consecutive patients treated with intravitreal bevacizumab for neovascular AMD, diabetic macular edema, and macular edema secondary to retinal vein occlusion that failed to achieve anatomic and visual goals despite previous photodynamic therapy (PDT), intravitreal pegaptanib (Macugen), intravitreal triamcinolone, laser photocoagulation, or
vitrectomy were retrospectively reviewed. Exclusion criteria included follow-up period shorter than one month and previously untreated neovascular AMD or macular edema. Studied variables included Snellen visual acuity, macular thickness by ocular coherence tomography (OCT), and prevalence of treatment-related adverse events.

RESULTS:

A total of 116 AMD patients and 33 macular edema patients met inclusion criteria. In the AMD group, 64% of patients received PDT, 41% received Macugen, and 28% received intravitreal triamcinolone before bevacizumab treatment. At the 3 months followup, 83% of patients experienced stable or improved vision. Although a 20% decrease in mean macular thickness was noted one week after injection, this anatomic improvement disappeared after 3 months of follow-up. In the macular edema group, 42% of patients received laser photocoagulation, 79% received intravitreal triamcinolone, and 48% underwent vitrectomy before bevacizumab treatment. At the 2 months followup, 83% of patients experienced stable or improved vision. Although a 27% decrease in mean macular thickness was noted one week after injection, this anatomic improvement also disappeared after 2 months of followup. One AMD patient developed persistently elevated IOP. No other significant complications were noted.

CONCLUSION:

Intravitreal bevacizumab can safely provide short-term stabilization of vision in patients with retinal and choroidal vascular diseases unresponsive to conventional treatments. A significant anatomic improvement is observed shortly after initiation of therapy but is lost fairly soon afterwards.