Treatment for wet type AMD and Diabetic Macular edema
Several studies looked at combination therapy with anti VEGFs, as well as investigative approaches to treatment and the risk of side effects.
Age-related macular degeneration (AMD) is the learning cause of legal blindness among elderly patients in developed countries.
The vast majority of severe vision loss due to AMD occurs in patients with the exudative (wet) form of the disease, in which the abnormal growth of new blood vessels beneath the retina (choroidal Neovascularization) CNV ultimately leads to irreversible loss of retinal function. Advances in our understanding of angiogenesis have facilitated the development of drugs specifically directed against CNV.
The most widely studied target has been vascular endothelial growth factor (VEGF), which plays a central role in the complex cascade of vessel growth, proliferation and hyperme ability.
One compound designed to bind to and inhibit VEGF have been developed for intravitreal delivery is Avastin (Bevacizumab)
This article will discuss the impact of Bevacizumab on the approach to patients with wet type AMD and diabetic macular edema.
Purpose:
To assess the use of Avastin (Bevacizumab) for the management of ARMD and Diabetic Maculopathy.
Study type: Interventional
Study design: Treatment, non-randomized, uncontrolled, single group assignment, safety /efficacy study.
Official title: Use of Avastin Intravitreal Injection for the treatment of ARMD and Diabetic Maculopathy.
Primary outcome measures:
• Change from baseline in VA, ie. Gain or loss of S letters (1 line), 15 letters (3 lines)
Secondary outcome measures:
• Change in OCT measured central retinal thickness.
Total Enrollment 2500
Study start: June 2005 Expected completion May 2008
Methodology:
Patients will be recruited from the vitreoretinal clinics at ESFAHAN National Eye center.
After initial assessment, clinically and angiographically, the patients will be counseled with regards to diagnosis, prognosis and management options including the option of intravitreal Avastin.
Inclusion criteria:
1. All subfoveal / juxtafoveal CNV in ARMD who are not eligible for other treatment options.
2. CNV Lesions which have failed PDT, conventional argon Laser photocoagulation.
3. CSME in diabetic patients due to MPC with regression or vit hemorrhages.
Exclusion criteria:
1. Patients with uncontrolled hypertension>150/90 mmHg.
2. history of thrombolitic events such as myocardial infarction or cerebral vascular accidents.
3. Renal abnormalities
4. coagulation abnormalities
5. patients with peptic ulcer disease
6. Pregnant or lactating females.
If the patient is eligible for the intravitreal treatment protocol, he/she will receive 1.50 mg of Avastin intravitreally.
The injections will be repeated every 4-5 weeks for a total of 3 treatments.
Results: in 450 injections 10 cases had uveitis and other ocular complications were 4 cases intraocular hemorrhage 2 cases retinal detachment and 2 cases of endophthalmitis.
Of our patients collective, 370 had diabetic retinopathy, 80 had wet type AMD.