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Intravitreal bevacizumab for pigment epithelial detachments in age-related macular degeneration

Intravitreales Bevacizumab zur Behandlung von Pigmentepithelabhebungen bei altersabhängiger Makuladegeneration

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Summary

Background

To evaluate the efficacy and safety of intravitreal bevacizumab injections in patients with pigment epithelial detachments (PEDs) secondary to age-related macular degeneration (AMD).

Material and methods

In a retrospective interventional case series, 62 eyes of 61 patients were treated with 1.5 mg bevacizumab intravitreally. Baseline and follow-up visits included best-corrected visual acuity and optical coherence tomography (OCT) examinations. Follow-up visits were performed 1, 3, and 6 months after initial treatment. Morphological effects on PED were quantified by repetitively measuring the highest elevation on two perpendicular OCT cross-sections. If height of PED was increased by 50 microns, or intraretinal fluid appeared or increased, or visual acuity decreased more than 5 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, patients were reinjected.

Results

On OCT, PED decreased from 346 ± 148 µm at baseline to 241 ± 159 µm (p < 0.001) at 1 month, 227 ± 193 µm (p < 0.001) at 3 months, and 166 ± 170 µm (p < 0.001) at 6 months. Mean best corrected visual acuity (BCVA) increased from 49 ± 18 letters at baseline to 52 ± 21 letters (p = 0.062) at 1 month. However, 3 and 6 months after initial injection mean BCVA returned to baseline levels (3 months: 49 ± 19 letters, p = 0.518; 6 months: 49 ± 20 letters, p = 0.053). On average, patients received 2.5 injections during the observation period of 6 months. Except for one retinal pigment epithelial (RPE) tear no other ocular or systemic adverse events were noticed. Ocular inflammation was not found in any of the investigated patients.

Conclusions

The presented data demonstrate a therapeutic effect of intravitreal bevacizumab in patients with specific classes of pigment epithelial detachments secondary to AMD.

Zusammenfassung

Hintergrund

Untersuchung der Wirksamkeit und Sicherheit von intravitrealen Bevacizumab-Injektionen bei Patienten mit Pigmentepithelabhebungen (PED) bei altersabhängiger Makuladegeneration (AMD).

Material und Methoden

In einer retrospektiven, interventionelle Fallserie wurden 62 Augen von 61 Patienten mit 1,5 mg intravitreal appliziertem Bevacizumab behandelt. Bei der Ausgangsuntersuchung und den Follow-up-Untersuchungen wurde die bestkorrigierte Sehschärfe bestimmt und eine optische Kohärenztomographie durchgeführt. Follow-up-Untersuchungen wurden 1, 3 und 6 Monate nach der ersten Behandlung durchgeführt. Morphologische Effekte auf die PED wurden in der OCT durch wiederholtes Messen der höchsten Erhebung auf zwei im rechten Winkel zueinander aufgenommenen OCT-Schnittbildern quantifiziert. Bei den Patienten wurden erneute Injektionen durchgeführt, wenn die Höhe der PED um mehr als 50 Mikrometer zunahm oder intraretinale Flüssigkeit entstand oder sich vermehrte oder wenn die Sehschärfe mehr als 5 Buchstaben auf den ETDRS Tafeln abnahm.

Ergebnisse

In der OCT reduzierte sich die Höhe der PED von 346 ± 148 μm bei Studienbeginn auf 241 ± 159 μm (p < 0,001) nach 1 Monat, 227 ± 193 μm (p < 0,001) nach 3 Monaten und 166 ± 170 μm (p < 0,001) nach 6 Monaten. Die mittlere bestkorrigierte Sehschärfe (BCVA) erhöhte sich von 49  ± 18 Buchstaben bei Studienbeginn auf 52 ± 21 Buchstaben (p = 0,062) nach einem Monat. Nach 3 und 6 Monaten nach der ersten Injektion fiel die BCVA jedoch wieder auf das Ausgangsniveau ab (3 Monate: 49 ± 19 Buchstaben, p = 0,518; 6 Monate: 49 ± 20 Buchstaben, p = 0,053). Im Durchschnitt erhielten die Patienten 2,5 Injektionen während der Beobachtungszeit von 6 Monaten. Außer einem Riss des retinalen Pigmentepithels (RPE) wurden keine anderen okulären oder systemischen Nebenwirkungen festgestellt. Okuläre Entzündungen wurden bei keinem der untersuchten Patienten gefunden.

Schlussfolgerungen

Die vorgestellten Daten zeigen einen therapeutischen Effekt der intravitrealen Bevacizumab-Applikation bei Patienten mit spezifischen Klassen von Pigmentepithelabhebungen bei AMD.

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Authors and Affiliations

  1. Dept. of Ophthalmology, University of Bonn, Bonn, Germany

    Victoria Hamelmann MD, FEBO, Hans -Martin Helb MD,FEBO, Carsten H. Meyer MD, Frank G. Holz MD & Nicole Eter MD

  2. Augentagesklinik MVZ ADTC Düsseldorf, Düsseldorf, Germany

    Victoria Hamelmann MD, FEBO

  3. Augenzentrum Westpfalz, Kaiserslautern, Germany

    Hans -Martin Helb MD,FEBO

  4. Dept. of Ophthalmology, Klinik Pallas, Olten, Switzerland

    Carsten H. Meyer MD

  5. Dept. of Ophthalmology, University of Münster, Domagkstr. 15, 48149, Münster, Germany

    Nicole Eter MD

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  1. Victoria Hamelmann MD, FEBO
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Correspondence to Nicole Eter MD.

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Hamelmann, V., Helb, HM., Meyer, C. et al. Intravitreal bevacizumab for pigment epithelial detachments in age-related macular degeneration. Spektrum Augenheilkd. 27, 184–195 (2013). https://doi.org/10.1007/s00717-013-0177-2

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