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Blake Isernhagen, Stephen Fransen; Association Between Required Length of Intravitreal Anti-VEGF Therapy in Exudative Age-Related Macular Degeneration and Initial Central Macular Thickness as Measured by Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6276.
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Anti-VEGF therapy has revolutionized the treatment of exudative age-related macular degeneration (AMD). Optical coherence tomography (OCT) is commonly used to help diagnose this disease and guide therapy. To date, no study has examined whether an association exists between OCT measured initial central macular thickness (CMTi) and required length of treatment in these patients.
Medical records were reviewed from patients at the Dean McGee Eye Institute with newly diagnosed exudative AMD from 2009 to 2010 who received intravitreal bevacizumab or ranibizumab therapy. Patients were divided into two groups: those who were able to stop therapy within 6 months of initiating treatment (Group 1) and those who had to continue therapy beyond 6 months or had to restart therapy after 6 months without treatment (Group 2). CMTi was recorded for all patients. We hypothesized that CMTi is significantly different between Group 1 and Group 2 patients.
Group 1 consisted of 88 eyes from 88 patients with an average age of 78.3 years, 43% were male. Mean CMTi was 318.1µm with maximal macular thickness of 384.5 µm. The range was 137 to 791 and 246 to 1156 respectively. Mean treatment duration was 4.2 months with a mean follow-up period of 16 months. Group two consisted of 96 eyes from 96 patients with an average age of 78.9 years, 40.6% were male. Mean CMTi was 375.9 µm with maximal macular thickness of 434.9 µm. The range was 207 to 818 and 263 to 818 respectively. The mean follow-up period was 18 months. CMTi and maximum macular thickness differences between Group 1 and 2 were statistically significant (Student's t-test, p < 0.05).
This is the first study demonstrating an association between initial macular thickness and how long a patient will require treatment for exudative AMD. We found a statistically significant difference between two groups requiring different durations of treatment. The mean CMTi difference was 67.8 µm and mean maximum macular thickness difference 50.4 µm. Initial OCT measurements may help predict how a patient will respond to anti-VEGF therapy.
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