Abstract

SO.21.07

Long-term intravitreal bevacizumab treatment for macular edema in retinal vein occlusion: Results of the German Avastin® study group

Gesine B. Jaissle1, Peter Szurman1, Hansjürgen T. Agostini2, Nicolas Feltgen3, Anastasia Dimopoulou1, Carsten H. Meyer4, für die Deutsche Avastin-Studiengruppe
1Department für Augenheilkunde, Universitäts-Augenklinik, Universitätsklinikum Tübingen, Tübingen, 2Universitäts-Augenklinik Freiburg, 3Universitäts-Augenklinik, Universitätsklinikum Göttingen, Göttingen, 4Universitäts-Augenklinik Bonn

Objective
The aim of this study was to investigate the functional and morphologic long-term effectiveness of intravitreal bevacizumab in the treatment of macular edema (ME) due to retinal vein occlusion. The large number of eyes included allowed for detailed subgroup analysis.
Methods
The study was based on the retrospective analysis of clinical data of the multicenter German Avastin® Study Group (Bonn, Freiburg, Leipzig, Liverpool, Muenster, and Tuebingen). 633 eyes received intravitreal bevacizumab therapy (1.25mg/0.05ml) to treat macular edema after branch retinal vein occlusion (BRVO, 303 eyes) or central retinal vein occlusion (CRVO, 330 eyes). Complete ophthalmic examination including optic coherence tomography in most of the eyes was done at baseline and at follow-up visits. The main outcome measures were visual acuity and central retinal thickness (CRT). The mean follow-up period was 26.9 weeks.
Results
In BRVO, the median visual acuity was 0.6 LogMAR at baseline, and improved to 0.4 LogMAR at 6 and 12 months. This visual improvement was paralleled by a reduction of the CRT. Ischemic macular edema showed a 3 lines increase of the median VA reaching a final median visual acuity of 0.5 logMAR. Patients younger than 60 years of age also showed a favourable 3 lines increase of the visual acuity, however with a final visual acuity of 0.15 logMAR. Negative influencing factors were poor baseline visual acuity, long standing macular edema (duration of BRVO of more than 1.5 years), and existence of pretreatment. In CRVO, the median visual acuity was 0.8 LogMAR at baseline, 0.6 LogMAR at 3 months and 0.7 LogMAR at 12 months. Repetitive bevacizumab injections were necessary in about one third of the patients with BRVO and in most of the patients with CRVO.
Conclusions
Intravitreal injection of bevacizumab results in a remarkable improvement of VA and reduction of ME in BRVO. Ischemic macular edema shows an excellent response although not reaching reading visual acuity in most of the eyes. As the therapy seems to have a negligible effect on longstanding macular edema, bevacizumab treatment should be applied within the first 18 months in the clinical routine. In CRVO, the long-term effect on visual acuity appears to be limited despite marked reduction of the CRT.

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