Bevacizumab (Avastin, Genentech) is a recombinant humanised, full length, anti-VEGF monoclonal antibody that binds all isoforms of VEGF-A. It has been shown to prolong survival of patients with advanced colon cancer when combined with 5-fluorouracil.¹ In this report, we describe the effect of bevacizumab in two patients with choroidal neovascularisation (CNV) secondary to pathological myopia, which was refractory to other treatment.

Case reports

Patient 1

AM is a 36 year old white man who was diagnosed with subfoveal CNV caused by pathological myopia (right eye  =  −11.50 D, left eye  =  −11.50 D) in his left eye in September 2002 for which he received three photodynamic therapy (PDT) treatments. He developed subfoveal CNV in his right eye in June 2003 and received one PDT treatment combined with an intravitreous injection of 4 mg of triamcinolone acetonide. In May 2004, he presented with recurrent subfoveal CNV in his right eye and refused PDT. Off-label use of bevacizumab was discussed and after informed consent, the patient decided to proceed.

Just before treatment in July 2004, best corrected visual acuity (VA) was 20/40 in the right eye and 20/25 in the left eye. There was a ring of hyperpigmentation centred on the fovea with a surrounding ring of subretinal blood and substantial subretinal fluid in the right eye (fig 1A). An optical coherence tomography (OCT) scan through the centre of the fovea confirmed the presence of extensive subretinal fluid (fig 1B, asterisks) with subretinal tissue in the centre of the fovea (arrowheads). An OCT map showed severe thickening and subretinal fluid throughout the centre of the macula (foveal thickness 510 μm, macular volume 9.29 mm³). In the left eye, there were pigmentary changes and no subretinal blood or fluid (foveal thickness, 201 μm). In the right eye, the early phase of a fluorescein angiography (FA) …