Intravitreal bevacizumab (Avastin) for occult choroidal neovascularization in age-related macular degeneration

Abstract

Short-term results suggest that intravitreal injection of bevacizumab is well tolerated and for the majority of patients with occult choroidal neovascularization in AMD results in improvement of visual acuity, decrease in central retina thickness, and reduction of angiographic leakage of the lesion. Bevacizumab as intravitreal treatment may provide a novel therapeutic option for selected patients with exudative AMD. Randomized prospective multicenter trials seem justified to further evaluate long term effects and impact of intravitreal bevacizumab on different subtypes of AMD compared to established therapies.

Randomised clinical trial of intravitreal Avastin vs photodynamic therapy and intravitreal triamcinolone: long-term results

“…6 Thereupon several studies evaluating the effectiveness of off-label treatment with intravitreal bevacizumab (IVB) have been performed. 7,8 Despite the lack of any randomised trial data and the frequent requirement for re-treatment, IVB has become a popular treatment for neovascular AMD.…”

Causes of interruption of bevacizumab therapy in age-related macular degeneration

“…The occurrence of AMD increases with age, so it is expected to become more prevalent in developed countries as life expectancy continues to increase (1)(2)(3)(4)(5) . Although exudative (or neovascular) AMD is less common than dry AMD, occurring in approximately 10 to 20% of the patients, it is usually responsible for most severe cases of vision loss (1,(6)(7) .…”

“…It has also been combined with intravitreal triamcinolone to permit more favorable results. Generally, results of PDT for subfoveal neovascular membranes have been limited to stabilization of the process and the visual acuity (1)(2)(5)(6) . Vascular endothelial growth factor (VEGF) has been proved to be important in the development of abnormal vessels and on the increase of its permeability in many pathological conditions.…”

“…With greater understanding of the role of VEGF in the pathogenesis of neovascular AMD, drugs inhibiting the bioactivity of VEGF have been developed and introduced in the clinical setting. Nowadays, intravitreal anti-VEGF represents a new paradigm in exudative AMD therapy due to its better outcomes (1)(2)(3)(4)7,(9)(10) . Bevacizumab (Avastin ® ) is a recombinant humanized fulllength anti-VEGF derived from a murine antibody with a molecular weight of 148 kD.…”

“…It has also been frequently and successfully used as an off-label intravitreal treatment of neovascular AMD since 2006. Bevacizumab has a longer halflife than ranibizumab, the actual most efficient anti-VEGF approved by ANVISA for AMD treatment, and is supposed to require less frequent dosing (1)(2)(3)(4)(5)(6)(7)(10)(11)(12) . Despite the better visual results achieved with bevacizumab therapy for choroidal neovascularization, its benefits seem to be temporary.…”