Aim: To determine the anatomical and functional outcome after injection of bevacizumab (Avastin, Genentech) in eyes with retinal angiomatous proliferation (RAP).
Design: Prospective interventional case series.
Methods: Sixteen eyes of 16 consecutive patients with visual loss due to RAP underwent intravitreal injections of 1.25 mg (0.05 ml) bevacizumab. Best corrected visual acuity testing, fluorescein and ICG-angiography as well as OCT imaging were performed at baseline and at each follow-up visit within a 3-month period.
Results: Mean visual acuity pre-injection was 0.68 +/- 0.36 logMAR (n = 16), mean reading ability 0.58 +/- 0.26 logRAD (n = 11). Far vision increased significantly by a mean of 1.7 +/- 2 lines 4 weeks after the injection (p = 0.004), as did reading (0.6 +/- 2.3 lines, p > 0.05). Both remained stable up to 3 months. Central retinal thickness decreased from 367 +/- 112 microm (mean+/-SD) to 272 +/- 123 microm 3 months after injection (p = 0.006). Leakage decreased angiographically in 12 eyes (75%) and remained stable in four eyes (25%). Re-injection of bevacizumab within the 3-month follow-up period was performed once in eight eyes, and twice in one eye. No adverse events were observed.
Conclusion: Intravitreal bevacizumab (Avastin) resulted in a reduction of leakage, intra- and subretinal fluid. An increase in visual acuity was seen already 4 weeks after first injection. However, a complete occlusion of feeder vessels could not be achieved within this 3-month period. Randomized clinical trials would be required to evaluate dose and frequency of injections and possible beneficial effects of combination therapies, as well as the long-term results.
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