Intravitreal bevacizumab for choroidal neovascularization associated with angioid streaks: Long-term results

Abstract

PURPOSE:The purpose of the study was to evaluate the long-term efficacy and safety of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS).MATERIALS AND METHODS:Noncomparative, interventional retrospective case series involving ten patients (15 eyes) with a minimum follow-up of 25 months following IVB for AS-associated CNV. Demographic and clinical details at baseline and during follow-up were collected from patient records. Detailed clinical examination was followed by fundus fluorescein angiography and optical coherence tomography to confirm CNV. Both primary and recurrent CNVs were treated with monthly injections of IVB till the lesion stabilized. Primary outcome measures were the percentage of patients with stable or improved visual acuity (VA) and with stable or decreased central retinal thickness (CRT) at the last visit. Secondary outcome measure was the incidence of ocular and systemic complications.RESULTS:Recurrence was observed in 11 eyes (73.33%) over a mean follow-up of 57.33 months (range: 25–100). A mean number of injections administered was 5.60. VA improved or stabilized in 73.33% and deteriorated in 26.67% of eyes at the final visit. Mean CRT improved from 324.40 μm at baseline to 265.53 μm at final visit, which was statistically significant. Complications observed were ocular hypertension in one patient and thromboembolic event in another patient.CONCLUSIONS:IVB appears to be a safe and effective option to treat CNV and to preserve vision over a prolonged period. It cannot eliminate the risk of recurrent CNV indicating the need for more effective treatments to arrest this visually debilitating condition.

Long-Term Prognosis of Choroidal Neovascularization Complicating Angioid Streaks

“…10 Many studies have confirmed the efficacy of intravitreal anti-VEGF therapy on CNV secondary to ASs. [13][14][15][16][17][18][19][20]27 Intravitreal injections have improved the functional outcome of these patients by controlling CNV activity. The French PIXEL study has shown that the mean VA was maintained at one year with treatment with 0.5 mg of ranibizumab and it remained stable for up to four years.…”

Intravitreal aflibercept for management of choroidal neovascularization secondary to angioid streaks

“…27 Since the advent of anti-VEGF, many groups have published their experience on the response of ASrelated CNV to antiangiogenic molecules. 14,15,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] Most of the studies showed that anti-VEGF agents are effective to stabilize, and in a minority of cases to improve, the visual acuity at long-term follow-up, irrespective of the administered molecule (i.e. bevacizumab, ranibizumab or aflibercept).…”

Case of angioid streaks treated with multiple different anti-vascular endothelial growth factor injection

“…10 In Lekha et al 11 study showed that recurrence was observed in 73.33% eyes after 5.60 bevacizumab injection over 57.33 months follow-up. 11 They concluded that more effective options are needed to reduce risk of recurrence. 11 Similarly, we observed sharp changes both significant decrease and increase in patient's visual acuity during the 5 bevacizumab injections in 2.5 years follow-up and first achieved positive anatomic and functional responses could not preserved, patient had complained of severe image distortion.…”