Bevacizumab is a recombinant full- length Anti- VEGF monoclonal antibody that binds to all isoforms of VEGF-A. initially developed for the treatment of colon cancer, intravenous Bevacizumab infusions have been shown to be useful in the treatment of CNV in AMD and PM (pathologic myopia).
In the systemic A vastin for neovascula AMD study reported by Michels, et al nine patients with subfoveal CNV were treated with systemic Bevacizumab, and treatment was found to result in significant visual improvement with marked reduction or absence of Leakage from the CNV after 12 weeks

Nguyen et al also reported the beneficial effect if systemic Bevacizumab in 2 patients with subfoveal CNV secondary to PM, which was refractory to other treatments including PDT and intravitreal triamcinolone actinides.
Patients with risk factors including old and systemic disease such as cardiovascular disease and cacers may, however, have increased risk of hypertension and thromboembolic events after systemic Bevacizumab. By changing the route of Bevacizumab administration from systemic infusion to intravitreal injection, a much lower dose of the drug can be used, and this might avoid the potential systemic side effects.
The use of intravitreal Bevacizumab was first reported by Rosenfeld and associates in a patient with subfoveal CNV attributable to AMD, and treatment resulted in symptomatic improvement and complete resolution of subretinal fluid at one week post- injection.
Subsequent case series have also demonstrated that intravitreal Bevacizumab resulted in significant visual improvement in patients with CNV secondary to AMD and PM.
The safety profile of intravitreal Bevacizumab appeared favorable because complications such as intravitreal inflammation as well as an increase in IOP and cataract were uncommon after intravitreal injection.
A recently published survey reporting the adverse events of more than 7000 intravitreal Bevacizumab injections from 70 centers worldwide also showed that the ocular and systemic complications rates are low and intravitreal Bevacizumab did not appear to increase the rate of potential drug- related ocular or systemic adverse events in the short- term

Animal and cell culture studies have also demonstrated that application of Bevacizumab appeared to result in good retinal penetration and did not result in significant retinal toxicity.
Based on these results on the safety and efficacy of intraitreal Bevacizumab, as well as the lower cost compared with other treatment options such as PDT with verteporfin, pegaptanib, and ranibizumab appears as a promising cost- effective treatment option for CNV.
In this prospective study, our results demonstrated that 3 monthly injections of intravitreal Bevacizumab resulted in complete regression of CNV with no angiographic Leakage in eyes at 6 month post- treatment. Moreover, no recurrence of CNV was observed at 6 months 400 eyes had improvement in BCV A with a mean improvement of 1.9 lines at 6 months as well as reduction in CFT on OCT. In 40 eyes no improvement in BCVA or CFT were seen and 10 eyes BCVA and CFT become worse.
The improvement in mean BCVA and CFT (OCT) were statistically significant at one month post- treatment and were maintained at the 6 months visit.
In our present study 75% of eyes had improvement of 2 or more lines following intravitreal Bevacizumab injections.
Moreover, visual and angiographic improvement were also observed in the 70% eyes with wet type ARMD despite previous PDT with verteporfin.
For CNV secondary to ARMD or DM intravitreal Bevacizumab also appeared to result in similar or more superior visual improvement compared with PDT, as the mean improvement after PDT was around 2 lines, 9,13, 14 whereas our results using intravitreal Bevacizumab coule result in a mean visual improvement of about 3 lines.
Based on these results, intravitreal Bevacizumab to be a promising treatment option for CNV due to wet type
ARMD and Diabetic Maculopathy.
Although our study was prospective, it contains several limitations including the lack of control group for comparison; secondly, the dosage of intravitreal Bevacizumab used has not been formally evaluated. We utilized a dosage of 1.50mg Bevacizumab in 0.05ml, which was the dosage most commonly used in other studies.
Moreover, the optimal number and frequency of intravitreal Avastin injection remained uncertain. Previous retrospective studies reporting the use of intravitreal Bevacizumab for CNV attributable to AMD or PM have used various numbers of injections among the patients.
We decided in the protocol monthly injections of intraviteal Bevacizumab followed by FA at one month to detect for any persistence of CNV. Regiment of 3 monthly intravitreal Bevacizumab injections was also used in the study by Bashshur et al and Spaide et al for the treatment of CNV attributable to AMD 21, 23 and the study by Wai- Man Chan et al for the treatment of CNV attributable to central serous chorioretinopathy and secondary to punctuate inner choroidopathy or of idiopathic origin our results showed that this injections regimen appeared to be effective in providing good angiographic occlusion of the CNV following treatment with minimal recurrence tate.
Future studies might consider investigating the proportion of eyes without angiographic Leakage after one or two intravitreal Bevacizumab injections. As it appeared that CNV secondary to the disease evaluated in this study might not need many treatments. In view of the encouraging results from this study, further prospective controlled studies to evaluate the long- term safety and efficacy of intravitreal Bevacizumab, the optimal treatment regimen, and the best measuring tool for the end point in wet type ARMD and diabetic Maculopathy are warranted