Intravitreous Avastin for diseases of ocular angiogensis

We propose to investigate the medium term safety and efficacy of the intravitreous use of Avastin ( Bevacizumab) to treat neovascular AMD (age related macular degeneration). The trial will be 12 to 18 months in duration, during which patients with (currently) untreatable AMD will be administered Avastin by intravitreous (into the vitreous cavity of the eye) injection. They will be monitered closely by conventional ophthalmic means (clinical assesment, fundus flurosceiun angiograhy etc…) and phyisical examination and assesment of cardiovascular parameters under the supervision of a consultant cardiologist. Avasatin (Bevacizumab, Genentech, Inc., South San Francisco, CA) is a humanized monoclonal antibody to VEGF (vascular endothelial growth factor) designed for intravenous administration and approved for the treatment of colorectal cancer. Its mechanism of action is to supress the action of the VEGF molecule and thereby prevent blood vessel growth with tumors. Its use in AMD is through the same mechanism. It is now widely used amongts retinal departments worldwide as an "off label" treatment for the full spectrum of neovascular (new blood vessel) AMD. The treatment has gained wdespread anecdotal noterity for its remarkable effect which has been transmitted to collegues by unconventially and informally by word of mouth and email. Objective and dispassionate analysis of Avastin in this disease has not yet been published in the peer reviewed litreature. There are several small cases series and some observational data (1-5). These reports, as well as the widespread anecdotal opinion do stongly suggest that Avastin is safe to the eye in the short term, and at least in a proportion of patients, dramatically effective, well beyond current coventional treatment. The primary aim of our study will be to assess the medium term SAFETY of Avastin, (both to the eye and to gerneral health) as well. to assses the EFFICACY of Avastin in treating neovascular AMD (choroidal neovacular membrane and polypoidal choroidal vasculopathy).