The Treatment of Choroidal Neovascularisations with Intravitreal Injections of Bevacizumab (Avastin®)

Zusammenfassung

Hintergrund: Obwohl Bevacizumab (Avastin®) lediglich für die Behandlung des kolorektalen Karzinoms zugelassen ist, haben zahlreiche Berichte gezeigt, dass seine intravitreale Anwendung bei choroidalen Neovaskularisationen (CNV) zu einer Stabilisierung oder sogar zur Rückbildung von pathologischen Gefäßneubildungen führen kann und sich dementsprechend positiv auf die Entwicklung der Sehschärfe auswirken kann. Patienten und Methoden: Zwischen April 2006 und Juli 2007 wurden die CNV verschiedener Ätiologie bei 300 Patienten (Altersdurchschnitt 75,78 Jahre) mit intravitrealen Injektionen von Bevacizumab (1,25 mg in 0,05 mL) behandelt. Für die Diagnosestellung und für die Kontrollen in zwölfwöchigen Abständen dienten Fluoreszenzangiografien und optische Kohärenztomografien. Die Injektionen fanden in sechswöchigen Abständen statt, bis die Makulabefunde als trocken beurteilt wurden. Die Prüfung der Sehschärfe erfolgte mittels ETDRS-Tafel. Ergebnisse: In allen untersuchten Gruppen konnte der Visus stabilisiert oder verbessert werden (+ 4,44 ETDRS Buchstaben nach 3,04 Injektionen im Schnitt). Während des Follow-up wurden sechs kardiovaskuläre Erkrankungen mit Tod in einem Fall diagnostiziert. Nach 1036 Injektionen konnte keine schwere okuläre Komplikation festgestellt werden. Schlussfolgerungen: Die Resultate zeigen deutlich, dass die intravitrealen Injektionen von Bevacizumab wirksam, sicher und kostengünstig sind. Weitere randomisierte Studien sind notwendig, um die dauerhafte Wirkung und die gute okuläre und systemische Verträglichkeit dieser Substanz zu bestätigen.

Abstract

Background: Although bevacizumab (Avastin®) has only been approved for the treatment of colorectal carcinoma, many reports have shown that its intravitreal administration against choroidal neovascularisations (CNV) leads to a stabilisation or even a regression of the pathological neovessels, and thus to a positive evolution of visual acuity. Patients and Methods: From April 2006 to July 2007, the CNV of different aetiologies were treated with intravitreal injections of bevacizumab (1.25 mg in 0.05 mL) in 300 patients with an average age of 75.78 years. Fluorescein angiography and optical coherence tomography were used for the diagnosis and for the checks which were carried out every twelve weeks. The intravitreal injections were performed every six weeks until the macular findings were considered to be dry. The visual acuity was checked using an ETDRS chart. Results: In all the groups considered the visual acuity was stabilised or improved on an average with + 4.44 ETDRS letters after 3.04 injections. During the follow-up six cardiovascular diseases were diagnosed and in one case a patient died. No ocular complications were reported after 1036 injections. Conclusions: The results clearly show that the intravitreal injections of bevacizumab are effective, safe and cost-effective. However, further randomised studies are needed to confirm the duration of the effect, as well as the good ocular and systemic tolerability of the drug.

Schlüsselwörter

choroidale Neovaskularisation - vaskulärer endothelialer Wachstumsfaktor

Key words

choroidal neovascularisation - vascular endothelial growth factor

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