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Britta E. Heimes, Albrecht Lommatzsch, Matthias Gutfleisch, Martha Dietzel, Meike Zeimer, Georg Spital, Daniel Pauleikhoff; Results Of Prn-regimen In Anti-vegf Therapy For Amd In Clinical Practice. Invest. Ophthalmol. Vis. Sci. 2011;52(14):113.
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The effectiveness of anti-VEGF-therapy in exudative AMD is well documented by large phase III studies, but parameters for clinical application, monitoring and the assessment of prognosis have not been defined. In Germany and the EU the retreatment criteria are predominantly depend on a decrease of visual acuity. The aim of the present Study was to investigate the effectiveness of this regimen.
In a prospective study we observed 153 patients with exudative AMD (15 class., 31 occ. choroidal neovascularization (CNV) with recent disease progression, 86 pigment epithelial detachments (PED) + occult CNV, 18 PEDs with RAP, 3 RAPs without PED) during injection therapy (first 3 Inj., then according to the PrONTO scheme) with Ranibizumab (Lucentis®) and assessed angiography (HRA II), best corrected VA and OCT (Spectralis-OCT HRAIII) stratified by presence of intraretinal cystoid cavities, subretinal fluid, presence of subfoveolar PED and discontinuity of photoreceptor-junction-layer (Phr-J-L) and RPE over a mean follow-up of 50 weeks.
Initially 64.7% of the patients showed an increase of visual acuity after 3 months of 0.27 logMAR. Despite re-treatment ( 5.9 Inj. in 12 months) most patients suffered in the long term follow-up a decrease of VA ( 0.17 logMAR). In line with this, a significant retinal re-thickening of 61 microns occurred after 52 weeks compared to the initial reduction after 12 weeks ( 112 µm). The AMD-Specification in FA showed no significant influence on development of VA, neither vitreous detachment nor presence of subfoveolar PED. Presence of cystoid spaces had no sign. Influence, but localization in the inner nuclear layer had a better visual outcome than those in the outer nuclear layer. Both, discontinuity of RPE and IS/OS-junction showed a trend to a worse VA over time.
Anti-VEGF treatment with a predominantly functionally based retreatment regimen in clinical praxis showed in mean a subtle decrease of VA. Therefore the regimen orientated at morphological characteristics seems to be more efficient. In Addition the Analysis of OCT parameters to predict Visual outcome Support the concept, that preexisting retinal and RPE changes are responsible for the different Visual course after treatment.
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