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Non-responders to bevacizumab (Avastin) therapy of choroidal neovascular lesions
  1. Anja Lux,
  2. Helene Llacer,
  3. Florian M A Heussen,
  4. Antonia M Joussen
  1. Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany and Department of Vitreoretinal Surgery, Center for Ophthalmology, University of Cologne, Cologne, Germany
  1. Antonia M Joussen, Department of Ophthalmology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; Joussena{at}googlemail.com

Abstract

Aims: To determine the characteristics of “non-responders” to intravitreal bevacizumab treatment in choroidal neovascularisation (CNV).

Methods: Forty-three patients with visual loss due to neovascular age-related macular disease (ARMD) (44 eyes) underwent intravitreal injections of 1.25 mg (0.05 ml) bevacizumab and were followed up every 4 weeks for 2, 3 or 6 months. Re-injection was performed when persistent leakage of the CNV was determined by fluorescein angiography and retinal oedema was assessed by optical coherence tomography (OCT). Non-responders were defined as those patients having reduced or stable visual acuity at the last follow-up.

Results: 45% of the patients were non-responders. In this group the initial CNV size was significantly larger than in the responders. Initial reading ability was significantly lower in non-responders, but the initial foveal oedema was similar in both groups. Gains in mean visual acuity and reading ability were independent of lesion type. The proportion of non-responders to responders in the different lesion type groups was equally distributed. Only patients with the classic type of CNV seemed to respond better.

Conclusions: In this study initial reasons for non-responders to intravitreal bevacizumab treatment in CNV are given. The efficiency of bevacizumab depends on initial lesion size and initial reading ability, but is independent of the amount of intraretinal and subretinal fluid. There was no general ineffectiveness of bevacizumab with any particular lesion type.

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Footnotes

  • Funding: This study was supported in part by Deutsche Forschungsgemeinschaft (DFG) grant Jo 324/6–2, the Brunnenbusch-Stein Stiftung, and the RetinoVit Stiftung, Cologne.

  • Competing interests: None.

  • Abbreviations:
    ARMD

    age-related macular disease

    CNV

    choroidal neovascularisation

    OCT

    optical coherence tomography

    PED

    pigment epithelial detachment

    PDT

    photodynamic therapy

    VEGF

    vascular endothelial growth factor

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