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Intravitreal bevacizumab (Avastin) therapy versus photodynamic therapy plus intravitreal triamcinolone for neovascular age-related macular degeneration: 6-month results of a prospective, randomised, controlled clinical study

¹ Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
² Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
³ Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland

Correspondence to:
Dr S Michels, Department of Ophthalmology, University Hospital Zürich, Frauenklinikstrasse 24, 8091 Zürich, Switzerland; stephan.michels{at}usz.ch

Aims: To compare functional and anatomical outcomes of intravitreal bevacizumab (Avastin) and verteporfin (photodynamic) therapy (PDT) combined with intravitreal triamcinolone (IVTA) in patients with neovascular age-related macular degeneration (AMD).

Methods: Twenty-eight patients with neovascular AMD were enrolled in a prospective, randomised, controlled clinical trial. All patients randomly assigned to 1 mg intravitreal bevacizumab (0.04 ml) received three initial treatments at 4-week intervals. In further follow-up retreatment was based on optical coherence tomography (OCT). Patients randomly assigned to standard PDT received a same-day intravitreal injection of 4 mg triamcinolone (Kenalog). Retreatment was based on fluorescein angiography at 3-month intervals. Functional and anatomical results were evaluated using the Early Treatment Diabetic Retinopathy Study protocol vision charts, fluorescein angiography and OCT.

Results: In the bevacizumab-treated group mean visual acuity (VA) improved to a 2.2 line gain at 6 months follow-up. Eyes treated in the PDT plus IVTA group had a stable mean VA at month 6 compared with baseline. There was a statistically significant difference (p = 0.03, analysis of variance (ANOVA)) between both groups as early as one day after initial treatment. The reduction in central retinal thickness (CRT) showed no significant difference between both groups (p = 0.3, ANOVA). Mean CRT was reduced from 357 µm at baseline to 239 µm at month 6 in bevacizumab-treated patients and from 326 µm to 222 µm, respectively, in PDT plus IVTA-treated patients. No significant local or systemic safety concerns were detected up to month 6.

Conclusion: Intravitreal bevacizumab showed promising 6-month results in patients with neovascular AMD. Functional outcomes appear not only to be dependent on a reduction in CRT but also on the treatment modality used.

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At a glance

Harminder S Dua and Arun D Singh, Editors-in
Br. J. Ophthalmol. 2008 92: 301. [Extract] [Full Text] [PDF]