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Intravitreal Avastin for choroidal neovascularisation in pathological myopia: the controversy continues
  1. P J Rosenfeld
  1. Correspondence to: P J Rosenfeld Bascom Palmer Eye Institute, University of Miami School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA; prosenfeld{at}med.miami.edu

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Intravitreal Avastin provides an opportunity to prevent visual acuity loss particularly in non-Western countries

In this issue, Yamamoto et al1 and Sakaguchi et al2(see page 157 and page 161) are the first to report the use of intravitreal Avastin (bevacizumab; Genentech, Roche) for the treatment of subfoveal choroidal neovascularisation (CNV) secondary to pathological myopia. The use of intravitreal Avastin in this disease is a natural extension of the previous work with intravitreal Avastin in neovascular age related macular degeneration (AMD). Last year, Michels et al3 reported on systemic Avastin for the treatment of neovascular AMD in nine patients followed over 3 months, and this cohort was subsequently expanded to 18 patients followed over 6 months.4 During these 6 months, the authors observed a rapid and sustained improvement in visual acuity and anatomical outcomes. Following the report of these initial observations, a much smaller dose of Avastin was injected intravitreally in a patient with CNV from AMD and a patient with macular oedema from a central retinal vein occlusion.5,6 The anatomical improvements were rapid and appeared very similar to the results observed after the systemic infusion of Avastin. Since these two case reports were published, numerous publications have supported the in vitro and in vivo safety of intravitreal Avastin,7,8,9,10,11,12,13,14,15 and several retrospective reviews and one prospective study have reported impressive improvements in visual acuity, angiographic and optical coherence tomography (OCT) outcomes in patients with neovascular AMD and macular oedema.16,17,18,19,20 Case reports have also shown dramatic improvements after administering intravitreal Avastin in eyes with proliferative diabetic retinopathy, neovascular glaucoma and cystoid macular oedema.21–26

The same progression of events is now taking place in the use of Avastin for …

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