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Lucia Finocchio, Daniela Bacherini, Fabrizio Giansanti, Giovanni Giacomelli, Cinzia Mazzini, Lorenzo Vannozzi, Ilaria Biagini, Gianni Virgili, Ugo Menchini; Intravitreal anti-VEGF therapy for vascularized serous pigment epithelial detachment in age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6267.
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To assess the efficacy of intravitreal bevacizumab and/or ranibizumab in the treatment of choroidal neovascularization (CNV) associated with serous pigment epithelial detachment (s-PED) due to age-related macular degeneration (AMD).
Retrospective, non comparative case series. We studied 26 consecutive eyes with occult CNV and serous PED secondary to AMD. Patients with a mean age of 75.3 years (SD:5.8) were treated with intravitreal anti-VEGF according to a pro re nata regimen (first loading phase of three monthly injections and then maintenance with injections as needed). 11 patients received ranibizumab, 6 bevacizumab and 9 eyes received both drugs. Best corrected ETDRS visual acuity (BCVA), optical coherence tomography (OCT) and fluorescein angiography (FA) were evaluated at baseline and quarterly. Mean follow-up ranged from 9 to 26 months (mean:13.5) after the first injection.
Mean baseline BCVA worsened from 0.46 LogMAR to 0.70 LogMAR at 9 months, up to 0.79 LogMAR at 1-year follow-up, which was a loss of 0.33 LogMAR. Mean greatest linear diameter (GLD) of PED increased from 4486 μm (SD:1324μm) at baseline to 4860 μm (SD:1924μm) at 1-year follow-up. The mean maximum height of PED was 578 μm (SD:304μm) at baseline and 344 μm (SD:223μm) after 12 months. The mean central retinal thickness (CRT) decreased from 271 μm (SD:90μm) at baseline to 260 μm (SD:126μm) at 1-year follow-up.There was no influence of either baseline BCVA or of number of anti-VEGF injections on visual outcomes (p>0.10). There was a borderline trend (p=0.064) of GLD on affecting response to treatment. Maximum height of PED and CRT did not influence functional outcomes (p>0.10). The mean number of injections was 5.5. An RPE tear occurred in 27% of the patients (n=7) on average after 3.5 injections. There was no difference in baseline GLD size and maximum height of PED between patients that developed RPE tear and patients without it.
In our study intravitreal anti-VEGF therapy did not prevent visual acuity loss and RPE tear rate was high. Therefore we believe that closer follow-up should be performed or a different treatment regimen should be adopted in this special subgroup of lesions. Patients should be alerted about the severe prognosis and the risk of vision loss due to RPE tear after anti-VEGF therapy.
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