OPTIMIZING INDIVIDUALIZED THERAPY WITH BEVACIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

PURPOSE: The purpose of this study was to evaluate a standardized retreatment strategy with intravitreal bevacizumab in the treatment of neovascular age-related macular degeneration. METHODS: In this double-masked randomized trial, patients with neovascular age-related macular degeneration were randomized to intravitreous bevacizumab or standard care. Bevacizumab treatment was given at 6 weekly intervals with 3 consecutive injections (loading phase) followed by variable dosing to Week 54 using standardized retreatment criteria. RESULTS: Three hundred and eighty retreatment decisions were made after 3 fixed injections for 64 patients randomized to bevacizumab that completed 1-year follow-up. The most common criterion for retreatment was persistent intraretinal fluid on optical coherence tomography imaging, and fluorescein angiography did not drive any retreatment decision. The mean (median) change in visual acuity and optical coherence tomography central macular thickness after the 3 loading treatments to Week 54 was +0.4 (+1.0) letters and +2.0 (+1.0) μm, respectively, with a mean (median) of 7.1 (7.0) injections. The median time to retreatment was 42 days with 12 of 69 injection-free episodes (17%) lasting more than 3 months. CONCLUSION: Sustained improvements in structure and function were achieved using this 6 weekly variable-dosing regimen with intravitreal bevacizumab. Most retreatment decisions were based on qualitative interpretation of optical coherence tomography scans.