Intravitreal bevacizumab for exudative branching vascular networks in polypoidal choroidal vasculopathy

To assess the long-term efficacy of intravitreal bevacizumab for recurrent leakage owing to the residual branching vascular networks in polypoidal choroidal vasculopathy after photodynamic therapy.

Forty-five eyes with exudative branching vascular networks were treated with intravitreal bevacizumab and followed for at least 24 months. Original polypoidal lesions had been treated successfully with previous photodynamic therapy in all eyes. The best-corrected visual acuity and retinal morphological changes were assessed retrospectively.

Exudative branching vascular networks were characterised as occult choroidal neovascularisation (38 eyes) or classic choroidal neovascularisation (7 eyes) on fluorescein angiography. Intravitreal bevacizumab maintained or improved vision in 38 eyes (84%) over 12 months and in 36 eyes (80%) over 24 months, although the mean visual acuity at 12 and 24 months did not differ significantly compared with baseline. Complete resolution of macular fluid was achieved continuously in 26 eyes (58%) during 24 months. Sixteen eyes (36%) responded once to treatment but became unresponsive to additional injections for recurrent exudation. Three eyes (7%) were refractory to treatment throughout follow-up. Cystoid macular oedema eventually developed in 10 eyes and was a poor prognostic sign for visual outcome.

Intravitreal bevacizumab improved the retinal morphology and maintained vision over 1 year in most eyes with recurrent fluid owing to persistent abnormal vascular networks in polypoidal choroidal vasculopathy. The therapeutic response, however, may decrease during the second year.