Aim: To assess the efficacy of intravitreal bevacizumab injections for eyes with neovascular age related macular degeneration (NVAMD) and poor initial visual acuity (VA).
Methods: Retrospective study of 44 consecutive treatment-naïve eyes with NVAMD who had initial VA of 0.1 decimal or worse, and that were treated with intravitreal bevacizumab injections. For the purpose of the study, charts, optical coherence tomography (OCT), and fluorescein angiograms (FA) were reviewed.
Results: Mean lesion size (SD) was 3375±2116 micron, all lesions showed sub- or intra-retinal fluid in OCT, and active neovascularization composed 41.6±17.7% (range 10-90%) of the lesion area according to FA. Patients received a mean of 2.6±2.42 bevacizumab injections (range: 1-14), and mean VA improved from 1.85±0.64 LogMAR to 1.52±0.77 LogMAR (p = 0.002). At final exam, 9 eyes (20%) had reduced VA, 10 eyes (23%) had stable VA, and 25 eyes (57%) had improved VA compared with baseline, respectively. Following treatment, mean macular thickness reduced from 332±98 micron to 248±79 micron (p < 0.0001).
Conclusions: Poor initial VA should not refrain from using bevacizumab in eyes with NVAMD. Selection of patients with signs of active neovascularization based on ophthalmoscopy, OCT, and FA may increase the likelihood of favorable response to treatment.