In select instances, administering Avastin® (bevacizumab) intravenously may be an effective way of treating patients with wet macular degeneration. In a short study, patients were randomly selected to be treated with either intravenous Avastin® or saline. Patients received only 3 infusions every two weeks and were followed for 24 weeks. Patients were observed for changes in the lesion size. (The “lesion” is the subretinal choroidal neovascular membrane, or abnormal blood vessel complex, which defines the “wet or exudative” form of macular degeneration.)
In about half the patients, the treated eyes became stable over the study period. Increase in blood pressure was noted after the Avastin® infusions, but was treatable.
The authors contend that intravenous administration of Avastin® may be an effective way to treat wet macular degeneration in patients who refuse intraocular injection, have both eyes involved, stable blood pressure and no history of vascular clotting.
What does this mean? No treatment is the perfect treatment for all patients. While this was only a small pilot study, there are a few notable points. Usually in ophthalmology we see trends for getting better drug delivery into the eye. Usually this means moving away from systemic dosing of drugs as the drugs usually do not get into the eye very well. This, however, does not mean that systemic therapy is bad. In this case, systemic therapy may actually be a useful way to treat this devastating visual disease in certain cases. It may provide hope to patients that can not tolerate intraocular injections. It may even require fewer treatments. Further study is certainly anticipated.
Randall V. Wong, M.D.
Ophthalmologist, Retinal Specialist