Intravitreal anti-VEGF therapy for neovascular age-related macular degeneration and the risk of stroke.

The purpose of this study was to compare the vascular event rate in AMD patients treated with an intravitreal VEGF inhibitor with a historical control group treated with photodynamic therapy. We reviewed medical records of 83 patients treated with intravitreal anti-VEGF for AMD between 2005-2007, and 60 patients treated with PDT between 2001-2004. Mean follow-up in the anti-VEGF group was 40 months versus 95 months in the PDT group. Mean age (76 +/- 9 years, versus 74 +/- 10 years, p=n.s.) and cardiovascular risk factor profile were similar. Vascular event rates in each group were 2.6 per 100 patient years versus 2.3 per 100 patient years, (p = n.s). Age over 80 years was associated with an increased risk of a vascular event (odds ratio = 1.113, p<0.05). Despite the high prevalence of risk factors in AMD patients, the incidence of vascular events was low and associated with older age rather than therapy received.

Intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration, 6- and 9-month results.

PURPOSE: To evaluate 6- and 9-month follow-up data including the effect on vision and anatomic outcome in patients treated with intravitreal bevacizumab for neovascular age-related macular degeneration (AMD). STUDY DESIGN: Interventional consecutive retrospective case series. Patients received intravitreal bevacizumab for the treatment of neovascular AMD including choroidal neovascular membranes, pigment epithelial detachment, and macular haemorrhage. Ophthalmic evaluation included log MAR or Snellen acuity, ophthalmic examination, optical coherence tomography, and fluorescein angiography. Repeat injections were given in the presence of persistent leakage or retinal oedema. Change in vision and foveal thickness from baseline was evaluated using the paired Student's t-test. RESULTS: A total of 112 eyes of 111 patients received injections. Median follow-up was 5 months (range: 1-12 months). Mean log MAR vision pre-injection was 0.84+/-0.03 (n=112); at 3 months was 0.69+/-0.05 (P<0.0001, n=84); at 6 months was 0.74+/-0.06 (P<0.05, n=51); and at 9 months was 0.69+/-0.08 (n=29, P=0.09). Thirteen of 17 patients who received only one injection maintained improved or stable vision at 6 months. Mean baseline foveal thickness was 291+/- 9.72 microm (n=56); at 3 months was 282.7+/-28 (P<0.05, n=31); and at 6 months was 249.7+/-10.3 (P<0.05, n=12). One case of endophthalmitis, three submacular haemorrhages, and three retinal pigment epithelial (RPE) tears occurred. CONCLUSION: Intravitreal bevacizumab is an effective treatment for neovascular AMD, resulting in improved vision and foveal anatomy at 6 months and even up to 9 months. This treatment is well tolerated in the majority of patients but adverse events may include endophthalmitis, RPE tears, and submacular haemorrhage.