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DOI: 10.1055/s-2008-1027638
© Georg Thieme Verlag KG Stuttgart · New York
Bevacizumab intravitreal zur Behandlung okkulter und minimal klassischer choroidaler Neovaskularisation (CNV) bei AMD
Intravitreal Injection of Bevacizumab for Exsudative AMD with Occult or Minimal Classic Choroidal Neovascularisation (CNV)Publication History
Eingegangen: 28.11.2007
Angenommen: 16.6.2008
Publication Date:
29 August 2008 (online)

Zusammenfassung
Hintergrund: Die systemische Gabe der Anti-VEGF-Therapie mit Bevacizumab zeigte bei der Behandlung der exsudativen, altersabhängigen Makuladegeneration in der SANA-Studie einen Therapieeffekt. Die intravitreale Verabreichung von Bevacizumab hat den Vorteil, dass mit geringen Dosen eine hohe Konzentration im Auge erreicht werden kann. Klinische Studien zeigten einen therapeutischen Effekt. Patienten und Methoden: In einer klinischen Studie erfolgte bei 93 Patienten mit okkulter oder minimal klassischer, choroidaler Neovaskularisation in einem Abstand von 8 Wochen eine intravitreale Eingabe von Bevacizumab (1,25 mg). Vor und jeweils 1, 3 und 6 Monate nach der Behandlung wurden Visuskontrollen, eine Messung des Augeninnendrucks, eine Fluoreszenzangiografie und eine OCT-Untersuchung durchgeführt. Jeweils einen Tag und eine Woche nach der intravitrealen Eingabe erfolgte eine Spaltlampenuntersuchung, eine funduskopische Untersuchung und eine Messung des Augeninnendrucks. Ergebnisse: Bevacizumab wurde gut vertragen und im Beobachtungszeitraum traten keinerlei Komplikationen auf. Einen Monat nach intravitrealer Eingabe war der mittlere Visus nicht signifikant verändert (0,26 vor, und 0,28 ein Monat nach Behandlung). Nach jeweils 3 und 6 Monaten zeigte sich der Visus mit 0,26 bzw. 0,27 stabil im Vergleich zum Ausgangwert. Bei einem Großteil der Patienten (75 %) zeigte sich in der Angiografie ein Rückgang der Leckage. Im OCT fanden wir eine signifikante Reduktion der zentralen Netzhautdicke (OCT: 323 µm Ausgangswert, 260 µm nach 1 Monat, 290 µm nach 3 Monaten, 275 µm nach 6 Monaten). Schlussfolgerung: Die intravitreale Applikation von Bevacizumab war sicher und wurde gut vertragen. Bei der Behandlung okkulter und minimal klassicher, choroidaler Neovaskularisationen stellt sie eine Therapieoption dar. Jeweils einen Monat nach intravitrealer Eingabe konnten der Mittelwert der Visuskontrolle, Leckagen in der Angiografie und die zentrale Netzhautdicke am stärksten gebessert werden. Ausgehend von unseren Ergebnissen könnten monatliche Eingaben den therapeutischen Effekt erhöhen.
Abstract
Purpose: Systemic anti-VEGF therapy with bevacizumab was effective in neovascular AMD in the SANA study. Intravitreal bevacizumab has the advantage that a high concentration can be achieved in the eye with a low dose. First clinical studies showed a good therapeutic effect. Methods: In a clinical study 93 patients with occult or minimal classic CNV due to neovascular AMD were treated with intravitreal injections of Bevacizumab (1.25 mg). Before, 1, 3 and 6 months after treatment visual acuity, intraocular pressure measurement, angiography and OCT examination were performed. After one day and after one week an eye examination was done and the intraocular pressure was measured. Results: Bevacizumab was well tolerated and we had no complications. Mean visual acuity was 20 / 80 at baseline. Visual acuity was stabilised but not significantly improved after 1, 3 and 6 months (20 / 80). 70 (75 %) patients showed reduced leakage in fluorescein angiography after 6 month. In OCT retinal thickness was reduced significantly after 1, 3 and 6 months (OCT: mean 323 µm at baseline, 260 µm after 1, 290 µm after 3 and 275 µm after 6 months). Conclusions: Intravitreal therapy with bevacizumab was safe and well tolerated. It is a therapeutic option in treating occult choroidal neovascularisations and minimal classic CNV. Six months after intravitreal administration of bevacizumab mean visual acuity was stabilised. Retinal thickness and leakage were more reduced after 1 month than after 3 and 6 months. According to our results, a monthly injection schedule could give more favourable results.
Schlüsselwörter
Retina - Glaskörper - Chorioidea
Key words
Retina - Vitreous - Choroid
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Dr. Mathias M. Maier
Augenklinik der TUM, Klinikum Rechts der Isar
Ismaningerstr. 22
81675 Munich
Phone: ++ 49/89/41 40 23 40
Fax: ++ 49/89/41 40 48 58
Email: M.Maier@lrz.tum.de