Bevacizumab dosing every 2 weeks for neovascular age-related macular degeneration refractory to monthly dosing

Purpose:To evaluate intravitreal bevacizumab every 2 weeks (biweekly) in refractory neovascular age-related macular degeneration (nAMD).Study design:Retrospective study.Methods:A retrospective study of consecutive nAMD patients unresponsive to monthly intravitreal anti-vascular endothelial growth factor (VEGF) switched to 3-4 biweekly injections.Results:Twenty-seven eyes of patients aged 82.08 6.85 years were included. Prior to the 2-week interval bevacizumab injections, 74.1% (n=20) were treated with both bevacizumab and ranibizumab, 11.1% (3 eyes) also received aflibercept and 14.8% (4 eyes) had received prior treatment of monthly bevacizumab (average number of injections 21.5 +/- 6.7). Best corrected visual acuity (BCVA) remained stable between baseline (logMAR 0.72 +/- 0.60) and follow-up (0.76 +/- 0.66) (p=0.41). Mean central macular thickness and macular volume did not change significantly between baseline and follow-up (p=0.35 and p=0.60, respectively). Six eyes (22.2%) showed morphologic anatomic improvements, while 19 eyes (70.4%) were stable and two eyes (7.4%) deteriorated from baseline. Subretinal fluid completely resolved in 3 of the eyes and improved in the other 3 eyes and in this group (22.2%) both central macular thickness (326.2 +/- 101.4 versus 297.5 +/- 97.2, p=0.002) and macular volume (8.69 +/- 1.69 versus 8.22 +/- 1.43, p=0.03) were significantly reduced. No adverse events were observed in any of the treated eyes.Conclusion: This study demonstrates that biweekly bevacizumab injections are effective in nearly one-quarter of nAMD non-responders with no adverse events reported. Switching earlier, rather than later, to this low cost modality may be of benefit for a portion of non-responders to conventional treatment.