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CNV size portends subretinal hemorrhage after anti-VEGF therapy
Change of choroidal neovascularization size on indocyanine green angiography can predict recurrent exudation and/or subretinal hemorrhage after treat-and-extend therapy for neovascular age-related macular degeneration, according to a study.
The retrospective study included 141 patients with neovascular age-related macular degeneration (AMD) who received bevacizumab (Avastin, Genentech) on a treat-and-extend basis for 12 months. Mean patient age was 77.3 years.
The treat-and-extend regimen comprised a loading dose of three consecutive monthly bevacizumab injections and subsequent monthly injections until the macula was seen to be dry, with no intraretinal or subretinal fluid or macular hemorrhage appearing on fundus examination.
Study results showed that treatment was successfully extended beyond 12 weeks in 30 of 141 patients (21.3%) and extended to 6 weeks or longer in 91 patients (64.5%). Extension failed between 4 and 6 weeks in the remaining patients.
Mean number of bevacizumab injections was 8.2.
Best corrected visual acuity improved significantly from a baseline, 20/60 to 20/43 (P < .0001).
Central macular thickness decreased significantly, from 386 μm to 309.7 μm (P < .0001).
Recurrent exudation was identified in 75.6% of patients after treatment extension at one or more follow-up intervals.
As seen on ICG angiography, CNV size increased 50% or more right before treatment extension in five of six patients (83.3%) in whom subretinal hemorrhages developed. In comparison, CNV size increased 50% or more before treatment extension in 13 of 119 patients (10.9%) who did not suffer subretinal hemorrhages (P < .0001). – by Matt Hasson
Disclosure: The study authors report no relevant financial disclosures.
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Rush RB, et al. Ophthalmic Surg Lasers Imaging Retina. 2015;doi:10.3928/23258160-20150730-05.