Korean J Ophthalmol.  2016 Aug;30(4):265-271. 10.3341/kjo.2016.30.4.265.

High Dose Intravitreal Bevacizumab for Refractory Pigment Epithelial Detachment in Age-related Macular Degeneration

• Lee DK
• Kim SH
• You YS
• Kwon OW

• KMID: 2373986
• DOI: http://doi.org/10.3341/kjo.2016.30.4.265

Abstract

PURPOSE
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) is the first choice of treatment for age-related macular degeneration. However, quite a few eyes treated using conventional dose anti-VEGF (CDAV) have persistent pigment epithelial detachment (PED) on optical coherence tomography. This study investigated the efficacy and safety of high dose anti-VEGF (HDAV) for refractory PED.
METHODS
In this retrospective study, 31 eyes of neovascular age-related macular degeneration patients with persistent PED findings despite six or more intravitreal injections of CDAV (bevacizumab 1.25 mg or ranibizumab 2.5 mg) were analyzed. Changes in visual outcome, central foveal thickness, and PED height were compared before and after HDAV (bevacizumab 5.0 mg) for these refractory PED cases.
RESULTS
The mean age of patients was 67.7 years. The number of CDAV injections was 12.1. The number of HDAV injections was 3.39. Best-corrected visual acuity in logarithm of the minimum angle of resolution before and after HDAV was 0.49 and 0.41 (p < 0.001), respectively. Central foveal thickness before and after HDAV was 330.06 and 311.10 µm (p = 0.125), respectively. PED height before and after HDAV was 230.28 and 204.07 µm (p = 0.014), respectively. There were no serious adverse reactions in all the eyes.
CONCLUSIONS
Increasing the dose of bevacizumab in refractory PED may be a possible treatment option.

Keyword

Age-related macular degeneration; Bevacizumab; Retinal pigment epithelial detachment; Vascular endothelial growth factor therapy

MeSH Terms

Aged
Angiogenesis Inhibitors/administration & dosage
Bevacizumab/*administration & dosage
Dose-Response Relationship, Drug
Female
Fluorescein Angiography
Fundus Oculi
Humans
Intravitreal Injections
Macular Degeneration/*complications/diagnosis/drug therapy
Male
Middle Aged
Retinal Detachment/diagnosis/*drug therapy/etiology
Retinal Pigment Epithelium/*diagnostic imaging/drug effects
Retrospective Studies
Tomography, Optical Coherence
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Angiogenesis Inhibitors
Bevacizumab
Vascular Endothelial Growth Factor A

Figure

• 

  Fig. 1 Change in best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution. BCVA was 0.45 ± 0.48 and 0.49 ± 0.43 before and after conventional dose anti-vascular endothelial growth factor (CDAV), respectively. BCVA showed a mean decrease of 0.05 ± 0.24 logarithm of the minimum angle of resolution (p = 0.278) despite CDAV. BCVA was 0.41 ± 0.42 after high dose anti-vascular endothelial growth factor (HDAV). BCVA showed a significant improvement of 0.08 ± 0.12 (*p < 0.001).

• 

  Fig. 2 Change in central foveal thickness (CFT). CFT was 321.03 ± 90.01 and 330.06 ± 106.01 µm before and after conventional dose anti-vascular endothelial growth factor (CDAV; mean change of CFT, 9.03 ± 77.48 µm; p = 0.521), respectively. CFT decreased to 311.10 ± 112.73 µm after high dose anti-vascular endothelial growth factor (HDAV; mean change of CFT, 18.79 ± 66.83 µm; p = 0.125).

• 

  Fig. 3 Change in height of pigment epithelial detachment (PED). The height of the PED was 227.46 ± 199.44 and 230.28 ± 134.36 µm after conventional dose anti-vascular endothelial growth factor (CDAV) treatment, respectively. The PED height decreased by a mean of 47.17 ± 39.44 µm with no statistical significance (p = 0.529). In contrast, eyes in the high dose anti-vascular endothelial growth factor (HDAV) group were found to have a final PED height of 204.07 ± 142.28 µm, which was significantly decreased by a mean of 18.79 ± 66.83 µm (*p = 0.014).

• 

  Fig. 4 (A) A 64-year-old man with pigment epithelial detachment (PED) secondary to age-related macular degeneration in right eye with subfoveal choroidal neovascularization was injected with conventional dose anti-vascular endothelial growth factor 28 times (ranibizumab 0.5 mg) during a 40-month period. Subfoveal PED persisted with no improvement of visual acuity. (B) Afterwards, bevacizumab 5.0 mg was injected monthly. Three months later, the marked PED noted on spectral domain-optical coherence tomography had resolved.

• 

  Fig. 5 (A) A 72-year-old woman with sub-retinal fluid and pigment epithelial detachment (PED) secondary to age-related macular degeneration in left eye was injected with conventional dose anti-vascular endothelial growth factor nine times (ranibizumab 0.5 mg × 3, bevacizumab 1.25 mg × 7) during a 10-month period. (B) No change in PED after three injections of ranibizumab 0.5 mg. (C) No change in PED after seven injections of bevacizumab 1.25 mg. (D) Significant improvement in PED after 2 monthly injections of bevacizumab 5.0 mg.

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