Japanese Journal of Ophthalmology

, Volume 54, Issue 6, pp 571–577

Predictors of response after intravitreal bevacizumab injection for neovascular age-related macular degeneration

Clinical Investigation

Abstract

Purpose

To identify fluorescein angiography (FA) and optical coherence tomography (OCT) characteristics predicting responses to intravitreal bevacizumab therapy in patients with neovascular age-related macular degeneration (AMD).

Methods

Results of 113 consecutive patients (113 eyes) treated with intravitreal bevacizumab injections for neovascular AMD were retrospectively reviewed. Patients were categorized into two groups according to visual acuity (VA) improvement 1 year after treatment: responders and nonresponders. Responders were defined as patients who achieved VA improvement ≥7 Early Treatment Diabetic Retinopathy Study (ETDRS) letters for occult choroidal neovascularization (CNV), and ≥11 ETDRS letters for classic CNV at month 12. N onresponders were defined as patients who did not meet the above VA improvement at month 12.

Results

Of the 113 eyes, 36 (31.9%) were categorized as responders and 77 (68.1%) as nonresponders. Nonresponders, compared with responders, had thicker subretinal tissue (SRT) (218.9 μm versus 180.9 μm, P = 0.040), and more frequent cystoid macular edema (CME) (42.9% versus 13.9%, P < 0.001).

Conclusion

Thick SRT and CME on OCT may be characteristic of nonresponders and may be helpful for tailoring treatment for neovascular AMD.

Keywords

AMD bevacizumab nonresponders OCT responders 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Klein R, Peto T, Bird A, Vannewkirk MR. The epidemiology of age-related macular degeneration. Am J Ophthalmol 2004;137:486–495.CrossRefPubMedGoogle Scholar
  2. 2.
    Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124:1754–1760.CrossRefPubMedGoogle Scholar
  3. 3.
    Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 2006;113:363–e365.CrossRefPubMedGoogle Scholar
  4. 4.
    Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006;355:1419–1431.CrossRefPubMedGoogle Scholar
  5. 5.
    Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006;355:1432–1444.CrossRefPubMedGoogle Scholar
  6. 6.
    Regillo CD, Brown DM, Abraham P, et al. Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol 2008;145:239–248.CrossRefPubMedGoogle Scholar
  7. 7.
    Fung AE, Lalwani GA, Rosenfeld PJ, et al. An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol 2007;143:566–583.CrossRefPubMedGoogle Scholar
  8. 8.
    Dadgostar H, Ventura AACM, Chung JY, Sharma S, Kaiser PK. Evaluation of injection frequency and visual acuity outcomes for ranibizumab monotherapy in exudative age-related macular degeneration. Ophthalmology 2009;116:1740–1747.CrossRefPubMedGoogle Scholar
  9. 9.
    Joeres S, Tsong JW, Updike PG, et al. Reproducibility of quantitative optical coherence tomography subanalysis in neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci 2007;48:4300–4307.CrossRefPubMedGoogle Scholar
  10. 10.
    Subramanian ML, Ness S, Abedi G, et al. Bevacizumab vs ranibizumab for age-related macular degeneration: early results of a prospective double-masked, randomized clinical trial. Am J Ophthalmol 2009;148:875–882 e871.CrossRefPubMedGoogle Scholar
  11. 11.
    Jyothi S, Chowdhury H, Elagouz M, Sivaprasad S. Intravitreal bevacizumab (Avastin) for age-related macular degeneration: a critical analysis of literature. Eye 2010;24:816–824.CrossRefPubMedGoogle Scholar
  12. 12.
    Landa G, Amde W, Doshi V, et al. Comparative study of intravitreal bevacizumab (Avastin) versus ranibizumab (Lucentis) in the treatment of neovascular age-related macular degeneration. Ophthalmologica 2009;223:370–375.CrossRefPubMedGoogle Scholar
  13. 13.
    Krebs I, Binder S, Stolba U, et al. Optical coherence tomography guided retreatment of photodynamic therapy. Br J Ophthalmol 2005;89:1184–1187.CrossRefPubMedGoogle Scholar
  14. 14.
    Sahni J, Stanga P, Wong D, Harding S. Optical coherence tomography in photodynamic therapy for subfoveal choroidal neovascularisation secondary to age related macular degeneration: a cross sectional study. Br J Ophthalmol 2005;89:316–320.CrossRefPubMedGoogle Scholar
  15. 15.
    Salinas-Alaman A, Garcia-Layana A, Maldonado MJ, Sainz-Gomez C, Alvarez-Vidal A. Using optical coherence tomography to monitor photodynamic therapy in age related macular degeneration. Am J Ophthalmol 2005;140:23–28.CrossRefPubMedGoogle Scholar
  16. 16.
    Moutray T, Alarbi M, Mahon G, Stevenson M, Chakravarthy U. Relationships between clinical measures of visual function, fluorescein angiographic and optical coherence tomography features in patients with subfoveal choroidal neovascularisation. Br J Ophthalmol 2008;92:361–364.CrossRefPubMedGoogle Scholar
  17. 17.
    Spaide RF, Laud K, Fine HF, et al. Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina 2006;26:383–390.CrossRefPubMedGoogle Scholar
  18. 18.
    Hee MR, Baumal CR, Puliafito CA, et al. Optical coherence tomography of age-related macular degeneration and choroidal neovascularization. Ophthalmology 1996;103:1260–1270.PubMedGoogle Scholar
  19. 19.
    Puliafito CA, Hee MR, Lin CP, et al. Imaging of macular diseases with optical coherence tomography. Ophthalmology 1995;102:217–229.PubMedGoogle Scholar
  20. 20.
    Rogers AH, Martidis A, Greenberg PB, Puliafito CA. Optical coherence tomography findings following photodynamic therapy of choroidal neovascularization. Am J Ophthalmol 2002;134:566–576.CrossRefPubMedGoogle Scholar
  21. 21.
    Voo I, Mavrofrides EC, Puliafito CA. Clinical applications of optical coherence tomography for the diagnosis and management of macular diseases. Ophthalmol Clin North Am 2004;17:21–31.CrossRefPubMedGoogle Scholar
  22. 22.
    Ahlers C, Simader C, Geitzenauer W, et al. Automatic segmentation in three-dimensional analysis of fibrovascular pigment epithelial detachment using high-definition optical coherence tomography. Br J Ophthalmol 2008;92:197–203.CrossRefPubMedGoogle Scholar
  23. 23.
    Fong DS, Custis P, Howes J, Hsu JW. Intravitreal bevacizumab and ranibizumab for age-related macular degeneration a multicenter, retrospective study. Ophthalmology 2010;117:298–302.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Ophthalmological Society (JOS) 2010

Authors and Affiliations

  • Yeo Jue Byun
    • 1
  • Sung Jun Lee
    • 2
  • Hyoung Jun Koh
    • 1
    • 3
  1. 1.Institute of Vision Research, Department of OphthalmologyYonsei University College of MedicineSeoulKorea
  2. 2.Department of Ophthalmology, Dongguk University Ilsan HospitalDongguk University School of MedicineGyeonggidoKorea
  3. 3.Department of OphthalmologyYonsei University College of MedicineSeoulKorea

Personalised recommendations