title: Standardized visual acuity results associated with primary versus secondary bevacizumab (avastin) treatment for choroidal neovascularization in age-related macular degeneration.
abstract: OBJECTIVE
  To compare standardized visual outcomes and macular thickness changes associated with primary and secondary bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) therapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD).
  
  
  METHODS
  Eighteen eyes received primary bevacizumab treatment; 20 eyes received pegaptanib (Macugen; Eyetech/OSI Pharmaceuticals, New York, NY) as initial treatment followed by bevacizumab therapy. Both medications were injected at 6-week intervals. Best-corrected visual acuity was measured with the ETDRS chart. Three- and 6-month data were analyzed for all eyes.
  
  
  RESULTS
  Mean visual acuity improvement in the primary bevacizumab treatment cohort was 1.5 ETDRS lines at 3 months (P = 0.0009) and 2.2 ETDRS lines at 6 months (P=0.0004) compared with -0.4 ETDRS line at 3 months (P=0.27) and 0.2 ETDRS line at 6 months (P=0.70) in the secondary bevacizumab treatment group. Mean decrease in retinal thickness was also higher in the primary bevacizumab treatment group (90.9 microm [P=0.0037] vs 43.8 microm [P=0.13], respectively) than in the secondary bevacizumab treatment group (73.72 microm [P=0.051] vs 33.0 microm [P=0.21], respectively) at 3 months and 6 months.
  
  
  CONCLUSIONS
  Primary bevacizumab therapy resulted in significantly greater visual improvement than secondary bevacizumab treatment at 3 months or 6 months. To our knowledge, this is the first report comparing primary bevacizumab treatment of CNV in AMD with secondary bevacizumab treatment after multiple pegaptanib injections.
authors.affiliation: Joan and Irwin Jacobs Retina Center, Department of Ophthalmology, University of California at San Diego, La Jolla, California 92037, USA.
authors.forename: Iryna A
authors.initials: IA
authors.lastname: Falkenstein
authors.forename: Lingyun
authors.initials: L
authors.lastname: Cheng
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Morrison
authors.forename: Igor
authors.initials: I
authors.lastname: Kozak
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Tammewar
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab