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Bevacizumab for myopic CNV results are encouraging
At 10-month follow-up, majority of patients in a small study improved in visual acuity and central foveal thickness.
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KOLOA, Hawaii — A retrospective case series of intravitreal bevacizumab injections for the treatment of myopic choroidal neovascularization shows improved visual results and good safety, according to one surgeon.
At the Retina 2007 meeting, held in conjunction with Hawaiian Eye 2007, Elias Reichel, MD, presented updated results from a study published in the British Journal of Ophthalmology on Avastin (bevacizumab, Genentech) intravitreal injections.
The updated results included data for 15 eyes of 13 patients, many of whom were included in the original study, followed for an average of 10 months. Six of the eyes included had previously failed photodynamic therapy treatment.
“Intravitreal Avastin clearly shows benefit in these eyes as primary treatment,” Dr. Reichel said.
Updated information
Dr. Reichel said myopic CNV is a serious subfoveal condition that can result in severe loss of vision if left untreated.
“Often, there is immediate irreversible loss of vision when these patients aren’t treated,” he said. “It has been reported in literature that almost 10% of eyes with degenerative myopia can develop [CNV] and, if untreated, greater than 90% of these eyes can go on to 20/200 vision after 10 years.”
The original study began after alternative treatments – ranging from observation and laser to PDT and intravenous bevacizumab – failed to meet safety or efficacy concerns.
That study, which included 11 eyes of nine patients, showed a mean increase in visual acuity of 3.5 lines. To further that study, Dr. Reichel said patients were added and followed for about 10 months.
Elias Reichel |
Dr. Reichel said of the updated study information: “Now that we have experience, we started treating patients with actual vision. There was one patient who was 20/20 to 20/40 vision.”
Baseline visual acuity was 20/20 to 20/40 in one eye, 20/50 to 20/100 in eight eyes and 20/200 or worse in six eyes. At the last follow-up exam, six eyes were 20/20 to 20/40, seven eyes were 20/50 to 20/100 and two eyes were 20/200 or worse. There was a mean improvement of three lines.
Baseline central foveal thickness was 324 µm and, at 10 months, central foveal thickness was 229 µm, for an average reduction of 93 µm, Dr. Reichel said.
For the treatment, one eye received five injections, one eye received three injections, two eyes received two injections and 11 eyes received one injection.
“In this small case series, there were really no complications. We didn’t observe retinal tears or retinal detachment,” Dr. Reichel said. “This has been a major concern since we’re treating eyes that are at high risk for developing retinal detachment or retinal tear, but it doesn’t appear to be the case.”
There were also no cases of endophthalmitis, he added.
Thoughts for future
Dr. Reichel noted that a majority of eyes in this updated study group needed only one or two injections, while some needed many to control CNV.
“There probably is a subgroup of patients who can respond to one or two injections of Avastin or Lucentis or whatever the medication du jour,” he said. “It is important for us to identify who those patients are because it will make our ability to predict who will require fewer injections in the future.”
Unfortunately, he said, these cases of myopic CNV are unusual and would not be conducive to a clinical trial.
“Because we aren’t going to have clinical trials for these oddball cases, we really have to pull our safety data from other case series and see if we are inducing retinal tears or detachment,” he said.
Dr. Reichel also added one cautionary note: “Most of the subjects were women, and it’s important to take a good history and obtain a pregnancy test in women of childbearing age. Personally, I won’t treat a pregnant woman.”
Still, he said, “I think that in our case, we would use Avastin as our first line of choice for treating highly myopic CNV and, again, data from other investigators would be nice, to confirm these findings.”
For more information:
- Elias Reichel, MD, can be reached at New England Eye Center, 750 Washington St., Box 450, Boston, MA 02111; 617-636-1648; fax: 617-636-4866; e-mail: ereichel@tufts-nemc.org. He has no financial interest in any of the companies or products mentioned.
- Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.
- David W. Mullin is Executive Editor of the international editions of OSN.