MyVisionTest News Archive
Oct 20, 2009
Long-term results of Avastin for angioid streaks
Avastin maintained visual acuity of patients with choroidal neovascularization (CNV) secondary to angoid streaks over a 1 year follow-up period, according to a new study.
Angioid streaks are fractures in Bruch's membrane, which allows for ingrowth of CNV into the subretinal space. CNV secondary to angioid streaks tends to affect middle-aged patients and are associated with poor visual prognosis when the macula is affected.
Laser photocoagulation has been used to treat CNV secondary to angoid streaks; however, high recurrence rates and functional problems related to the progression of CNV or laser-induced scars have encouraged development of other treatment options. The efficacy of photodynamic therapy (PDT) for maintaining macular function seems to be short-lived due to frequent recurrence and subsequent chorioretinal atrophy. Favorable short-term results in the treatment of CNV secondary to angioid streaks have been reported in previous studies. However, it is unknown if the drug is effective over the long-term.
Methods and Results
Fifteen eyes of 13 patients (5 men, 8 women; mean age: 59 years; range: 54-70 years) treated with 1-mg intravitreal Avastin injections were included. The minimum follow-up after the first injection was 12 months. Eyes that had undergone previous treatments were excluded. The best-corrected visual acuity (BCVA) was measured. Optical coherence tomography and fluorescein angiography images were examined before and after treatment.
The mean follow-up was 19 months (range, 12 to 24 months). The mean number of injections for primary CNV was 4.5. The mean preoperative BCVA (decimal equivalent) was 0.39 and 0.47 at the final visit (P = .355). The BCVA improved by 2 lines of visual acuity at the final visit in 5 eyes (33%), was unchanged in 8 eyes (54%), and decreased in 2 eyes (13%).
The final fluorescein angiography examination showed no leakage in 10 eyes (67%), minimal leakage in 2 eyes (13%), and persistent or recurrent leakage in 3 eyes (20%). Five eyes (33%) had a recurrence 4 to 7 months (mean: 5.1 months) after the last Avastin injection. New CNV lesions developed in different areas in 3 eyes (20%) 6 to 14 months after the last Avastin injection for primary CNV.
Discussion and Conclusions
This study found that CNV secondary to angoid streaks became quiescent after injection of Avastin and VA stabilized. However, with follow-up times exceeding 1 year, recurrent or newly developed CNV in different areas was seen in half of the study eyes. Fortunately, additional Avastin injections resulted in these eyes becoming quiescent.
The vision results from the current study are not as good as for a previous study of 11 eyes with subfoveal CNV secondary to angoid streaks followed for an average of 20 months. In the earlier study, the VA improved significantly from 0.28 to 0.56 at 20 months, whereas in the current study of the 6 eyes with subfoveal CNV the vision decreased slightly from 0.27 to 0.25 at the final visit.
The major problem in managing CNV in eyes with angioid streaks is recurrence. With laser photocoagulation the recurrence rate was 77%. Because of repeated treatments with laser photocoagulation or PDT, additional ruptures in the Bruch membrane may occur and may lead to more recurrences. Avastin may not induce direct damage to the Bruch membrane; however, recurrence seems to be unavoidable over the long-term. In the current study the recurrence rate was 33%. Furthermore, new CNV developed in different areas in 20% of the eyes 6 to 14 months after the last Avastin injection.
It is unclear how often bevacizumab injections are needed to treat CNV secondary to angioid streaks to achieve quiescence. Based on the results of this study, additional Avastin injections sooner than 4 months after the previous injection may be necessary to avoid recurrence even after achieving quiescence.
The investigators conclude that intravitreal injection of Avastin seems to maintain visual acuity. However, CNV frequently recurred or new CNV developed during the long follow-up.
Read more...
Am J Ophthalmol. 2009 Oct;148(4):584-590
Tags: Avastin, angioid streaks, prognosis, Japan
Avastin maintained visual acuity of patients with choroidal neovascularization (CNV) secondary to angoid streaks over a 1 year follow-up period, according to a new study.Angioid streaks are fractures in Bruch's membrane, which allows for ingrowth of CNV into the subretinal space. CNV secondary to angioid streaks tends to affect middle-aged patients and are associated with poor visual prognosis when the macula is affected.
Methods and Results
Fifteen eyes of 13 patients (5 men, 8 women; mean age: 59 years; range: 54-70 years) treated with 1-mg intravitreal Avastin injections were included. The minimum follow-up after the first injection was 12 months. Eyes that had undergone previous treatments were excluded. The best-corrected visual acuity (BCVA) was measured. Optical coherence tomography and fluorescein angiography images were examined before and after treatment.
The mean follow-up was 19 months (range, 12 to 24 months). The mean number of injections for primary CNV was 4.5. The mean preoperative BCVA (decimal equivalent) was 0.39 and 0.47 at the final visit (P = .355). The BCVA improved by 2 lines of visual acuity at the final visit in 5 eyes (33%), was unchanged in 8 eyes (54%), and decreased in 2 eyes (13%).
The final fluorescein angiography examination showed no leakage in 10 eyes (67%), minimal leakage in 2 eyes (13%), and persistent or recurrent leakage in 3 eyes (20%). Five eyes (33%) had a recurrence 4 to 7 months (mean: 5.1 months) after the last Avastin injection. New CNV lesions developed in different areas in 3 eyes (20%) 6 to 14 months after the last Avastin injection for primary CNV.Discussion and Conclusions
This study found that CNV secondary to angoid streaks became quiescent after injection of Avastin and VA stabilized. However, with follow-up times exceeding 1 year, recurrent or newly developed CNV in different areas was seen in half of the study eyes. Fortunately, additional Avastin injections resulted in these eyes becoming quiescent.
The vision results from the current study are not as good as for a previous study of 11 eyes with subfoveal CNV secondary to angoid streaks followed for an average of 20 months. In the earlier study, the VA improved significantly from 0.28 to 0.56 at 20 months, whereas in the current study of the 6 eyes with subfoveal CNV the vision decreased slightly from 0.27 to 0.25 at the final visit. The major problem in managing CNV in eyes with angioid streaks is recurrence. With laser photocoagulation the recurrence rate was 77%. Because of repeated treatments with laser photocoagulation or PDT, additional ruptures in the Bruch membrane may occur and may lead to more recurrences. Avastin may not induce direct damage to the Bruch membrane; however, recurrence seems to be unavoidable over the long-term. In the current study the recurrence rate was 33%. Furthermore, new CNV developed in different areas in 20% of the eyes 6 to 14 months after the last Avastin injection.
It is unclear how often bevacizumab injections are needed to treat CNV secondary to angioid streaks to achieve quiescence. Based on the results of this study, additional Avastin injections sooner than 4 months after the previous injection may be necessary to avoid recurrence even after achieving quiescence.
The investigators conclude that intravitreal injection of Avastin seems to maintain visual acuity. However, CNV frequently recurred or new CNV developed during the long follow-up.
Read more...
Am J Ophthalmol. 2009 Oct;148(4):584-590
