Two reports in the British Journal of Ophthalmology retrospectively examine the use of intravitreal bevacizumab in patients with neovascular age-related macular degeneration (AMD).

The first study looked at baseline visual and optical coherence tomography (OCT) factors on outcomes after intravitreal bevacizumab treatment in 73 eyes treated with intravitreal bevacizumab. The primary outcomes were change in best corrected Snellen visual acuity (BCVA) and central retinal thickness (CRT) on OCT.

Seventy-three (100%) and 58 (79.5%) eyes were followed for 3 and 6 months, respectively, and the following findings were reported:

• The mean BCVA improved from 20/177 to 20/160 (p=0.03) at 3 months and to 20/143 (p=0.04) at 6 months.

• The mean CRT decreased 93µm (p < 0.0001) and 105µm (p < 0.0001) at 3 and 6 months, respectively.

• Baseline BCVA worse than 20/100 was associated with greater visual improvement (p ≤ 0.04).

• Eyes with baseline CRT greater than 400µm experienced a greater mean CRT reduction (p < 0.05).

• Treatment-naïve patients had a greater mean CRT reduction than those previously treated with any modality (p<0.05).

The researchers conclude that “baseline BCVA and CRT positively influence mean visual and CRT improvement, respectively, after intravitreal bevacizumab in wet AMD. Any prior treatment predicted less CRT reduction.”

The second study assessed efficacy of intravitreal bevacizumab injections in 44 consecutive treatment-naïve eyes with initial VA of 0.1 decimal or worse. The mean lesion size was 3375μm, all lesions showed sub- or intra-retinal fluid in OCT, and active neovascularisation comprised a mean of 41.6% of the lesion area. The mean follow-up time was 3.9 months and patients received a mean of 2.6 injections. The following findings were reported:

• Mean VA improved from 1.85 to 1.52 LogMAR (p = 0.002).

• At final examination, 9 eyes (20%) had reduced VA, 10 eyes (23%) had stable VA and 25 eyes (57%) had improved VA compared with baseline.

• Following treatment, mean macular thickness was reduced from 332 to 248μm (p<0.0001).

The researchers suggest from these findings that “poor initial VA should not prevent use of bevacizumab in eyes with neovascular AMD. Selection of patients with signs of active neovascularisation based on ophthalmoscopy, OCT and FA may increase the likelihood of a favourable response to treatment.”