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charlotte so, Zac Ravage; Choroidal Thickness following Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4098.
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To evaluate choroidal thickness via enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT) in patients receiving multiple intravitreal anti-vascular endothelial growth factor (VEGF) injections for neovascular age-related macular degeneration (nAMD).
A retrospective chart review of 11 eyes of 9 patients with nAMD treated with intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept, as needed) was performed. EDI SD-OCT was obtained routinely on each nAMD patient on monthly follow-up visits once it became readily available in our clinic. We analyzed patients with 6 or more injections prior to this time point. Choroidal thickness was calculated on each subsequent exam by manually measuring between the RPE and inner sclera at 5 standard points within the macula and averaged, according to published protocol. Change in thickness was then compared between the initial measurement and months 2, 4, 6, and 8. Results were analyzed using SPSS software.
A total of 8 eyes of 7 patients were included in this study. Mean number of prior injections was 12 (7-17). Mean follow-up was 9 months (8-10). Mean choroidal thickness on initial measurement was 143.48 + 31.30, 141.33 + 35.81 at 2 months, 146.26 + 34.29 at 4 months, 145.45 + 35.19 at 6 months, and 147.35 + 39.13 at 8 months. The change in choroidal thickness over the 8-month period was not statistically significant (p=0.428).
Published data on the long-term effects of anti-VEGF therapy on choroidal thickness is conflicting, but may suggest a decrease after as few as 3 injections. This small pilot study describes thinner choroids in eyes presenting with an average of 12 prior injections. Over the following 8 months, there was no statistically significant change with further treatments. Further study with a larger sample size and longer follow up is needed to confirm choroidal thinning with anti-VEGF therapy and determine the significance of these changes.
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