Intravitreal bevacizumab improved vision in most patients with myopic CNV

Intravitreal bevacizumab safely improved vision in most patients with choroidal neovascularization secondary to pathological myopia, according to two small studies in the February issue of the British Journal of Ophthalmology.

In one study, Izumi Yamamoto, MD, and colleagues at the New England Eye Center reviewed results of 11 eyes of nine patients treated with 1.25 mg of Avastin (bevacizumab, Genentech) between August 2005 and January 2006.

Before treatment, all eyes showed retinal signs of pathological myopia or had a minimum refractive error of –6 D, according to the study. Pre-injection visual acuity ranged from 20/50 to 20/100 in six eyes and 20/200 or worse in five eyes.

At 153 days' mean follow-up, visual acuity was 20/20 to 20/40 in seven eyes, 20/50 to 20/100 in one eye and 20/200 or worse in three eyes. Mean visual acuity improved by 3.5 lines, and central foveal thickness decreased by an average 103 µm, the authors said. No injection- or drug-related complications occurred, although three eyes required a second injection, they noted.

"The results of intravitreal bevacizumab for the treatment of myopic CNV are promising," the authors said, noting that longer-term follow-up for a larger patient group is needed to establish safety and efficacy.

In a second study, H. Sakaguchi and colleagues at Osaka University Medical School in Japan reviewed outcomes of eight eyes of eight patients treated with 1 mg of intravitreal Avastin for myopic CNV. All patients had a spherical equivalent of less than –8 D.

Before treatment, best corrected visual acuity averaged 0.26. At a minimum 3 months' follow-up, mean BVCA had significantly improved to 0.51 (P = .009), improving by two or more lines in six eyes (75%) and staying the same in two eyes (25%), according to the study.

Fluorescein angiography showed significant reductions in neovascular leakage in seven eyes (87.5%), falling from a mean 0.72 Da to 0.64 Da after treatment (P = .049). Ocular coherence tomography showed foveal thickness had also significantly decreased from 198.4 µm to 155.1 µm after treatment (P = .027). No adverse events were reported.

"[The] turnover of intravitreal bevacizumab may be slower because the function of the thinner retina and the retinal pigment epithelium in highly myopic eyes may deteriorate," the authors said. "Thus, long-term side effects after injection of 1 mg bevacizumab intravitreally should be investigated in a future study."