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STANDARDIZED VISUAL ACUITY RESULTS ASSOCIATED WITH PRIMARY VERSUS SECONDARY BEVACIZUMAB (AVASTIN) TREATMENT FOR CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION

Purpose: 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 &mgr;m [P = 0.0037] vs 43.8 &mgr;m [P = 0.13], respectively) than in the secondary bevacizumab treatment group (73.72 &mgr;m [P = 0.051] vs 33.0 &mgr;m [P = 0.21], respectively) at 3 months and 6 months. Conclusion: 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.