The Role of VEGF in vascular AMD
F B. Aggio, Michel Eid Farah, W. C. Silva, G. B. Melo (Sao Paulo)
Background: Photodynamic therapy with verteporfin (PDT) significantly reduces the risk of
vision loss in patients with exudative age-related macular degeneration (AMD). However, a
substantial subset of patients responds poorly to the treatment. Intravitreal bevacizumab has
been recently used in the treatment of exudative AMD, showing both visual and anatomic
improvement in the majority of cases.
Methods: This interventional retrospective case series reports the effects of intravitreal bevacizumab
in 22 eyes with subfoveal neovascular AMD that had undergone repeated PDT, combined
or not with triamcinolone acetonide, with poor results. Main outcome measures were
visual acuity, angiographic leakage and tomographic signs of intra/subretinal fluid, as well as
central retinal thickness.
Results: Most patients received a single intravitreal bevacizumab injection. Mean follow-up was 12.8 weeks. Mean logMAR
visual acuity improved from 1.04 ± 0.45 to 0.93 ± 0.47 (P = 0.059). Mean central retinal thickness decreased from 309.81± 77.5 mm to 254.54 ± 71.91 mm (P = 0.009). At the end of the study, lack of angiographic leakage was noted in 15 (68.2%)
eyes and tomographic signs of intra/subretinal fluid were absent in 13 (59%) eyes. No ocular or systemic side effects were
identified.
Conclusions: Intravitreal bevacizumab appears to be safe and effective in the management of exudative AMD after repeated
PDT. However, the chronic retinal and pigment epithelium changes frequently present in these eyes may limit complete
visual recovery. To our knowledge, this is the first report on the use of intravitreal bevacizumab for this particular group of
AMD patients.