Abstract:
• Purpose: To compare the efficacy of as-needed or variable dosing of intravitreal bevacizumab to continuous fixed-interval dosing in the management of neovascular age-related macular degeneration (AMD). • Design: Prospective, open-label, randomized clinical study. • Methods: One hundred twenty eyes of 120 patients with treatment-nave subfoveal neovascular AMD participated in this study at the American University of Beirut and Hotel Dieu de France Retina Clinics. Eyes were randomized (1:1) to fixed-interval dosing (every 4 to 6 weeks) or variable dosing with intravitreal bevacizumab (1.25 mg-0.05 mL). Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using optical coherence tomography (OCT) were measured at baseline and at each follow-up visit. Presence or recurrence of fluid on OCT was the main indicator for retreatment in variable dosing. Main outcome measure was improvement in BCVA and CRT at 12 months. • Results: Compared to baseline, variable dosing had a mean improvement in BCVA of 11.0 letters after 12 months vs 9.2 letters for fixed-interval dosing (P =.81). Similarly, CRT decreased after 12 months by 80.7 μm for variable dosing vs 100.5 μm for fixed-interval dosing (P =.37). The average number of injections over 12 months was higher for fixed-interval dosing than variable dosing (9.5 vs 3.8 injections, P .001). • Conclusions: Fixed-interval and variable dosing regimens of intravitreal bevacizumab improved visual acuity and anatomic outcomes after 12 months in eyes with neovascular AMD. However, variable dosing had a reduced treatment burden. Larger trials are needed to confirm these results. © 2012 Elsevier Inc. All rights reserved.