Korean J Ophthalmol.  2008 Jun;22(2):92-99. 10.3341/kjo.2008.22.2.92.

The Therapeutic Effects of Bevacizumab in Patients with Polypoidal Choroidal Vasculopathy

• Lee SY
• Kim JG
• Joe SG
• Chung H
• Yoon YH

• KMID: 1099002
• DOI: http://doi.org/10.3341/kjo.2008.22.2.92

Abstract

PURPOSE: To evaluate the efficacy and safety of intravitreal bevacizumab for polypoidal choroidal vasculopathy (PCV). METHODS: In this retrospective interventional pilot study, 12 eyes of 11 patients with active PCV were treated with intravitreal bevacizumab (1.25 mg) alone or in combination with photodynamic therapy (PDT) depending on the informed patient's choice. Intravitreal bevacizumab was repeated at 6-week intervals until the regression of active lesion was detected on fluorescein angiography (FA) which was done on a regular basis, Indocyanine green angiography (ICGA) and optical coherence tomography (OCT) analyses. RESULTS: Intravitreal bevacizumab was given alone in 8 eyes (Group 1) and in combination with PDT in 4 eyes (Group 2). Mean follow-up duration was 17 weeks in group 1 and 15 weeks in group 2 after bevacizumab treatment. The mean number of bevacizumab injections was 2.2 in group 1 and 2.5 in group 2. Mean BCVA improved from 20/63 to 20/40 in group 1 and 20/63 to 20/32 in group 2. Of all eyes, the BCVA improved by > or =2 lines in seven (58%) eyes and resolution of fluid and hemorrhages in clinical examination, an absence of leakage on repeat FAs, or resolved pigment epithelial detachment (PED) and/or subretinal fluid (SRF) on OCT exam was confirmed in 10 (83%) eyes. Partial or complete regression of the polypoidal vessels and interconnecting vessels was reported for most cases at the last follow-up. No significant ocular or systemic side effects were observed in both groups. CONCLUSIONS: Short-term results indicate that intravitreal bevacizumab (1.25 mg) alone or in combination with PDT is well tolerated and associated with improvement in BCVA and reduced angiographic leakage in most patients. Further evaluation of intravitreal bevacizumab therapy for the treatment of PCV is warranted.

Keyword

Intravitreal bevacizumab; Polypoidal choroidal vasculopathy; Photodynamic therapy

MeSH Terms

Aged
Aged, 80 and over
Angiogenesis Inhibitors/adverse effects/*therapeutic use
Antibodies, Monoclonal/adverse effects/*therapeutic use
Choroid/*blood supply/pathology
Coloring Agents/diagnostic use
Combined Modality Therapy
Female
Fluorescein Angiography
Humans
Indocyanine Green/diagnostic use
Injections
Male
Middle Aged
Peripheral Vascular Diseases/diagnosis/*drug therapy/physiopathology
*Photochemotherapy
Pilot Projects
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A/antagonists & inhibitors
Visual Acuity/physiology
Vitreous Body

Figure

• 

  Fig. 1 Case 4, with exudative maculopathy in the right eye. (A) Fundus photograph showing subretinal blood and subretinal serous detachment. (B) Midphase fluorescein angiogram (FA) showing an irregular hyperfluorescent area corresponding to the interconnecting vascular network (arrow). (C) Fundus photograph 4 weeks after photodynamic therapy (PDT) showing a massive subretinal hemorrhage, including the posterior pole. (D) Fundus photograph after two intravitreal bevacizumab injections followed by an intravitreal injection of tissue plasminogen activator (t-PA) and 100% C3F8 (0.3 ml), showing chorioretinal scarring.

• 

  Fig. 2 Case 3, left eye, the fellow eye of the case 4 patient (Fig. 1). (A) Midphase indocyanine green angiogram (ICGA), showing multiple polypoidal dilations of choroidal vessels and an interconnecting network. (B) Optical coherence tomograph (OCT) showing subfoveal serous elevation and a polypoidal lesion (arrow head). (C) Midphase ICGA showing reduced polypoidal lesion and interconnecting vessels. (D) OCT after three intravitreal bevacizumab injections, showing reduced subretinal fluid and a polypoidal lesion re-attached to the Bruch's membrane and choroids (arrow head).

• 

  Fig. 3 Case 8 with persistent active polypoidal choroidal vasculopathy (PCV) 4 months after photodynamic therapy (PDT). (A) Fundus photograph showing dense subretinal hemorrhages and serous subretinal detachment. (B) Midphase fluorescein angiogram (FA) showing hypofluorescence corresponding to a subretinal hemorrhage and multiple dot-shaped hyperfluorescent lesions. (C) Midphase indocyanine green angiogram (ICGA) showing multiple polypoidal dilations of choroidal vessels and an interconnecting vascular network. (D) Fundus photograph after three intravitreal bevacizumab injections, showing resolved subretinal hemorrhages and serous subretinal detachment. (E) Midphase FA after three intravitreal bevacizumab injections, showing only the retinal pigment epithelium (RPE) window defect without angiographic leakage in late phase (not shown). (F) Midphase ICGA after three intravitreal bevacizumab injections, showing regression of the polyps and an interconnecting vascular network.

• 

  Fig. 4 Case 12 (A) Fundus photograph showing some hemorrhages, subretinal serous detachment, and subretinal exudates. (B) Optical coherence tomograph (OCT) showing serous pigment epithelial detachment (PED). (C) Midphase fluorescein angiogram (FA) showing hyperfluorescence with serous PED and round, multiple isolated hyperfluorescence lesions and surrounding irregular hyperfluorescence. (D) Midphase indocyanine green angiogram (ICGA) showing multiple polypoidal dilation of the choroidal vessels and interconnecting network. (E) Fundus photograph after three intravitreal bevacizumab injections and one round of photodynamic therapy (PDT), showing reduced hemorrhages and subretinal serous elevation. (F) OCT after three intravitreal bevacizumab injections and one round of PDT, showing resolved serous PED. (G) Midphase fluorescein angiogram (FA) after three intravitreal bevacizumab injections and one round of PDT, showing reduced hyperfluorescence and reduced subretinal fluid. (H) Midphase ICGA after three intravitreal bevacizumab injections and one round of PDT, showing resolved polypoidal lesion and interconnecting vessels.

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