Comparing systemic to intravitreal bevacizumab (Avastin®)
in patients with neovascular AMD
Stephan Michels (Vienna)
Bevacizumab (Avastin®), a monoclonal antibody designed to bind all isoforms of the vascular
endothelial growth factor (VEGF), has shown promising results in exudative 30 mm respectively).
At 8 to 12 weeks follow-up mean CRT was near to normal values (220 to 250 mm). Both
treatment regimens characteristically showed first a resolution of intraretinal edema, followed
by resorption of subretinal fluid and subsequent resolution of a pigment epithelial detachment
(PED). Quantitative analysis of PED height and diameter showed systemic bevacizumab to significantly
reduce both parameters at 3 months follow-up. At 3 months follow-up patients treated
with systemic or intravitreal bevacizumab had a mean improvement in vision of 10.5 and 8
ETDRS letters respectively. Functional macular mapping using Nidek MP1 indicated in patients
treated systemically a 50% reduction in absolute scotoma size at 3 months follow-up.
None of the systemically or intravitreally treated patients had a serious adverse event. The only adverse event seen in
patients treated systemically was a transient rise in systolic blood pressure, easily controlled by oral blood pressure
medication. Flare measurements on patients treated with 1 mg intravitreal bevacizumab even indicated an anti-inflammatory
effect.
Both treatment modalities show comparable initial treatment responses, however, factors as cost and treatment durability
have to be taken into consideration. Long-term follow-up is required to further outline advantages and disadvantages of both
treatment modalities using bevacizumab in patients with neovascular AMD.