The treatment of choroidal neovascularizations in age-related macular degeneration using either Avastin or Lucentis

The safety of intravitreal bevacizumab monotherapy in adult ophthalmic conditions: systematic review

OBJECTIVES

To assess the safety of intravitreal bevacizumab (IVB) as a monotherapy and to evaluate the relationship between quality of treatment and adverse events.

DATA SOURCES

Cochrane Library, Ovid MEDLINE, MEDLINE in-process, Ovid EMBASE and Toxicology Literature Online (TOXLINE) from January 2009 to May 2012. Studies included in an earlier systematic review were also assessed for inclusion.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS

Randomised controlled trials (RCTs), controlled trials or observational studies including ≥10 participants reporting adverse events data following IVB monotherapy as a primary treatment in patients (aged 18 years or more) with any eye condition were included.

STUDY APPRAISAL AND SYNTHESIS METHODS

Study selection was undertaken independently by a minimum of two reviewers using pre-defined criteria. Data abstraction and quality assessment were performed by one reviewer, and then checked by a second reviewer. Study quality was assessed for only RCTs in accordance to the Cochrane Risk of Bias Tool. Additional items relating to safety data were also assessed. Results were tabulated or meta-analysed as appropriate.

RESULTS

22 RCTs and 67 observational studies were included. Only two RCTs reported valid safety data. Rates of serious adverse events following treatment were low. There was insufficient data to explore the relationship between the incidence of adverse events and quality of IVB injection.

LIMITATIONS

A majority of relevant existing studies were characterised by small sample sizes, unclear diagnostic criteria and reporting of safety outcomes.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Available evidence demonstrates low rates of serious local and systemic adverse events following treatment. However, the role of IVB quality in the incidence of adverse events remains unclear. Robust evidence is needed to examine the relationship between the incidence of adverse events and variables such as injection techniques, pre-existing risk factors (eg, immunosuppression, cross-contamination) and quality of IVB treatment.

Association between foveal microstructure and visual outcome in age-related macular degeneration

PURPOSE

To investigate the correlation between foveal photoreceptor integrity and final visual acuity after treatment of eyes with neovascular age-related macular degeneration, and to determine the visual prognostic factors.

METHODS

We retrospectively studied 40 eyes of 40 patients with neovascular age-related macular degeneration who were treated successfully with intravitreal anti-vascular endothelial growth factor injection. Using spectral-domain optical coherence tomography, the eyes were categorized into three groups at the final visit, the V group with a completely visible photoreceptor inner and outer segment junction (IS/OS), the P group with a partially detected IS/OS, and the I group with an invisible IS/OS. The length of disrupted IS/OS and external limiting membrane, central macular thickness, and choroidal neovascularization size at the initial and final visits were measured. Retinal pigment epithelium regularity and outer nuclear layer thickness at the final visit were also evaluated.

RESULTS

Final visual acuity was closely associated with IS/OS integrity at the final visit. Final visual acuity (logarithm of minimum angle of resolution) in the V group (0.13 ± 0.10) was better than that in the P group (0.41 ± 0.31), and final visual acuity in the P group was better than that in the I group (0.97 ± 0.51) (P < 0.001). Shorter disrupted IS/OS and external limiting membrane length at the final visit were closely associated with better final visual acuity. Preservation of the IS/OS and external limiting membrane, thinner central macular thickness, and shorter choroidal neovascularization height before treatment were associated with intact photoreceptor integrity after resolution of exudation. However, central macular thickness, outer nuclear layer thickness, and retinal pigment epithelium regularity at the final visit had no significant correlation with photoreceptor integrity.

CONCLUSION

Foveal photoreceptor integrity was closely associated with final visual acuity in neovascular age-related macular degeneration after treatment. Initial visual acuity, IS/OS and external limiting membrane integrity, central macular thickness, and choroidal neovascularization height were correlated with final photoreceptor integrity, and they would be visual prognostic factors after resolution of exudation.