Flexibly Dosed Intravitreal Bevacizumab Monotherapy For Choroidal Neovascular Membranes Of Non-AMD Aetiologies

1.Anand Rajendran¹
2.Shashank Gupta¹
3.Kim Ramasamy¹

¹Aravind Eye Hospital, Madurai, India

PURPOSE: To report an angiographic and tomographic analysis of flexibly dosed isolated intravitreal bevacizumab therapy of choroidal neovascular membranes (CNVMs) of multiple Non-AMD aetiologies.

METHODS: Intravitreal bevacizumab (1.25mg/0.05 ml) was administered to 76 eyes with CNVMs of Non-AMD aetiologies using the pro-re-nata (PRN) dosing strategy. Clinical evaluation, snellen visual acuity (SVA), fluorescein angiography (FA), optical coherence tomography (OCT) were done at baseline and followup visits. Reinjection was done for recurrences. Regression trends with respect to SVA, FA, OCT, size , type, location and etiology were analysed.

RESULTS: Of the 76 cases,64 (86%) regressed. The regression rates amongst the individual aetiologies were idiopathic CNVMs [19/22(86%)], myopic [14/16(88%)], IJT [11/13(85%)], post-CSCR [9/11(82%)], angioid streaks [6/8(75%)], [5/6(83%)] post-uveitic. Regression trends on angiographic analysis were Classic CNVMs [10/11(91%)]; Predominantly classic [23/27(85%)];Minimally Classic [20/24(83%)]; Occult [11/14(79%)] {p=0.864} . Location based regression rates – subfoveal [38/46(83%)]; juxtafoveal [15/18(83%)]; extrafoveal [11/12(92%)] {p=0.740}. Size based regression trends - <2mm[19/21(91%)]; 2-4mm[38/38(89%)]; >4mm[11/17(65%)] {p=0.043}. Average gain in SVA at 1 month +1.2 lines, 3 months +1.5 lines, 6 months +1.4 lines,12 months +1.5 lines. Mean foveal thickness at baseline 372µm, 1 month 226µm, 3 months 241µm, 6 months 238µm, 12 months 233µm. Average number of re-injections were 3.7. Mean recurrence-free period was 4.2 months in a mean followup period of 13.1 months. The good prognostic factors identified were classic type, small lesions(< 2mm) and thin lesions (<300µm).

CONCLUSION : The PRN dosing strategy of intravitreal bevacizumab monotherapy is effective for CNVMs of various Non-AMD etiologies.