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Intravitreale Anti-VEGF-Therapie mit Bevacizumab bei neovaskulärer AMD

Intravitreal anti-VEGF therapy with bevacizumab for neovascular AMD

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Zusammenfassung

Hintergrund

Untersucht wurde der Effekt von intravitreal appliziertem Bevacizumab als Off-Label-Therapie bei verschiedenen angiographischen Subtypen der neovaskulären altersabhängigen Makuladegeneration (AMD).

Methoden

75 Patienten mit neovaskulärer AMD und „recent disease progression“ wurden angiographischen Subtypen zugeordnet und mit intravitrealem Bevacizumab (1,25 mg/0,05 ml) in 6-wöchigen Abständen therapiert. Bei subfovealer klassischer choroidaler Neovaskularisation (CNV) erfolgte zusätzlich eine photodynamische Therapie. ETDRS-Visus, ophthalmologische Untersuchungen und optische Kohärenztomographien (OCT) wurden vor Therapie, nach einer Woche und in 6-wöchigen Intervallen durchgeführt. Weiterhin erfolgen Fluoreszenzangiographien und internistische Kontrolluntersuchungen.

Ergebnisse

Bei allen angiographischen Subtypen führte die Bevacizumab-Therapie während einer Nachbeobachtungszeit von 37±13 Wochen im Mittel zu einer Visusstabilisierung (Verlust von weniger als 15 Buchstaben). Patienten mit okkulter extrafovealer CNV (n=6) erzielten den höchsten Visusanstieg (2±2 Linien). Die Bevacizumab-Therapie wurde von allen Patienten ohne systemische oder intraokulare Nebenwirkungen sehr gut vertragen. In einem Fall kam es zum Riss des retinalen Pigmentepithels.

Schlussfolgerung

Intravitreale Bevacizumab-Injektionen wirken bei allen angiographischen CNV-Subtypen im Sinne einer Makulaödemreduktion und führen zu einer Visusstabilisierung bzw. -besserung.

Abstract

Purpose

To report on the efficacy of intravitreal bevacizumab as off-label therapy in different angiographic subtypes in neovascular age-related macular degeneration (AMD).

Methods

Seventy-five patients with neovascular AMD and recent disease progression were classified into different angiographic subtypes and were treated with intravitreal bevacizumab (1.25 mg/0.05 ml) at 6-week intervals. Patients with subfoveal classic choroidal neovascularization (CNV) also received photodynamic therapy. ETDRS visual acuity, ophthalmic exams, and optic coherence tomography (OCT) were performed before treatment, 1 week after treatment, and then on a 6-week basis. Fluorescein angiographies and medical check-ups were also done.

Results

Bevacizumab led to stabilization of visual acuity (loss of less than 15 letters) in all angiographic subtypes during a follow-up of 37±13 weeks. Patients with occult extrafoveal CNV (n=6) profited the most and gained 2±2 lines. Treatment with intravitreal bevacizumab was very well tolerated in all patients, with neither systemic nor intraocular side effects, with the exception of one retinal pigment epithelium tear.

Conclusion

Intravitreal bevacizumab treatment is efficacious in all angiographic CNV subtypes and leads to reduction of macular edema and stabilization or improvement in visual acuity.

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Schaal, K., Engler, C., Schütt, F. et al. Intravitreale Anti-VEGF-Therapie mit Bevacizumab bei neovaskulärer AMD. Ophthalmologe 105, 538–543 (2008). https://doi.org/10.1007/s00347-007-1638-2

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  • DOI: https://doi.org/10.1007/s00347-007-1638-2

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