Avastin in myopic choroidal neovascularisation: is age the limit?

There are a growing number of publications supporting the use of Avastin (bevacizumab) for choroidal neovascularisation (CNV) secondary to pathological myopia (table 1).1^–8 In this issue, Arias et al (see page 1035) reported a prospective study of 17 patients;9 at the 6-month follow-up, the mean Early Treatment Diabetic Retinopathy Study visual acuity improved by 8.4 letters (p = 0.04), and the mean optical coherence tomography (OCT) foveal thickness decreased by 79.6 µm (p = 0.002). Is it time to change our clinical practice? Is it time to abandon photodynamic therapy (PDT) as the first line treatment? The purist would say that the only evidence base from randomised controlled trials is still that provided by the Verteporfin in Photodynamic Therapy (VIP) Study.10 11 In this study, PDT was shown to be effective in preventing visual loss fewer than eight letters in pathological myopia in the first year when compared with sham treatment.10 However, the effect of PDT was not sustained by the end of the second year.11 Smaller case series have shown similar results.11 Other investigators have attempted to improve the efficacy of PDT by enhancing the fluence13 or combining PDT with intravitreal triamcinolone acetonide injection.14 15 These studies failed to persuade, either limited by the small number …