title: Induction with intravitreal bevacizumab every two weeks in the management of neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To explore the benefit of rapid induction with intravitreal bevacizumab for neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Single-institution prospective randomized pilot study.
  
  
  METHODS
  Patients with treatment-naïve neovascular AMD were randomized 1:1:1 into 1 of 3 groups based on the induction sequence: (1) every 2 weeks for 3 consecutive injections; (2) every 4 weeks for 3 consecutive injections; and (3) immediate pro re nata (prn) after the first injection. Retinal angiomatous proliferation and polypoidal choroidal vasculopathy were excluded. Best-corrected visual acuity (BCVA) and central retinal thickness using optical coherence tomography (OCT) were measured at baseline and at each follow-up. After induction, bevacizumab was administered as needed based mainly on OCT. Main outcome measure was mean initial fluid-free interval after induction. Secondary outcomes were mean improvement in BCVA and central retinal thickness.
  
  
  RESULTS
  Each group included 30 patients (30 eyes). Mean initial fluid-free interval was 2.4, 3.4, and 3.5 months for biweekly induction, monthly induction, and immediate prn groups, respectively (P = .03). Significance was lost when corrected for age and sex (P = .073). Mean improvement in BCVA, central retinal thickness, and total number of injections were similar among the groups at 12 months. Six eyes in the biweekly induction group developed subretinal fibrosis vs no eyes in the other 2 groups (P = .003).
  
  
  CONCLUSIONS
  Biweekly induction with intravitreal bevacizumab for treatment-naïve neovascular AMD does not increase initial fluid-free interval or cause significant anatomic and functional benefit compared to monthly induction or immediate prn. There is also the potential development of subretinal fibrosis with biweekly induction.
authors.affiliation: Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
authors.forename: Anita
authors.initials: A
authors.lastname: Barikian
authors.affiliation: Department of Global and Public Health, Weill Cornell Medical College, Doha, Qatar.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Mahfoud
authors.affiliation: Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
authors.forename: Marwan
authors.initials: M
authors.lastname: Abdulaal
authors.affiliation: Department of Ophthalmology, American Hospital Dubai, Dubai, United Arab Emirates.
authors.forename: Ammar
authors.initials: A
authors.lastname: Safar
authors.affiliation: Department of Ophthalmology, American University of Beirut, Beirut, Lebanon. Electronic address: zb00@aub.edu.lb.
authors.forename: Ziad F
authors.initials: ZF
authors.lastname: Bashshur
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab