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Ilkka J Immonen, Asta Hautamaki, ; Anterior chamber flare during a prospective 2 year study of pro re nata (PRN) treatment of exudative age-related macular degeneration (AMD) with intravitreal bevacizumab injections.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2831.
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© ARVO (1962-2015); The Authors (2016-present)
Anterior chamber flare (Acfl) serves as a measure of the integrity of the blood-eye barrier (BEB). Vascular endothelial growth factor (VEGF), a key mediator of neovascularization in exudative AMD, is capable of disrupting the BEB. We analyzed how Acfl correlates with the activity and clinical characteristics of exudative AMD during a prospective 2-year study of treatment with intravitreal bevacizumab injections.
Fifty patients with exudative AMD were treated with bevacizumab. The reinjections were given at monthly visits in PRN-fashion. Acfl was measred weekly during the first month and monthy thereafter.
The median Acfl was 6.6 photons/msec (range 0.1 to 19.6) at baseline, increasing by 0,55 (-6.5 to 4.0) at one week. At weeks two and three the mean Acfl decreased compared to baseline, by -0.35 (-5.9 to 4.5) and -0,25 (-6.3 to 2.8, p=0.004), respectively. Also in the fellow eyes of the patients the Acfl increased from a baseline value of 6.1 photons/msec (0.4 to 25.7) by 0.35 (-5.6 to 7.2, ) at one week, decreasing to values below baseline by 0.0 (-7.1 to 4.4) and 0,25 (-6.3 to 2.8, p=0.025) at weeks two and three respectively During follow-up in the eyes, in which reinjections were not given at all visits, the median Acfl was lower at visits with no fluid in the macula, if the maculla had been dry for more than one month (p=0.001). However,an increase in Acfl did not predict the need for reinjection in these eyes.The median Acfl during follow-up was 6.9 (0.1 to 20.9) and 6.5 (0.1 to 25.7) in the study and fellow eyes respectively. Compared to baseline, the median follow-up Acfl decreased in eyes with a classic component in the lesion (changes from baseline - 0.2 (-2.08 to 1.64) and +0.33 (-5.2 to 4.8), respectively). In the 7 fellow- eyes that developed wet AMD during follow-up, the Acfl values were higher during the first month compared to those that did not develop wet AMD.
There is an increase in Acfl one week after the first injection both in the injected and the fellow eyes.During follow-up, in measurements taken at least one month after the previous injection, the median overall Acfl did not significantly differ from baseline. Lower values were observed, however, during extended periods of no-fluid in the macula and in eyes with a classic component in the lesion.
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