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Priyatham S. Mettu, Sara Crowell, Jeremy Shaw, Lili Grunwald, Eleonora M. Lad, Neha Serrano, Scott W. Cousins; Neovascular Morphology on ICG Angiography Predicts Response to Anti-VEGF Therapy in Eyes with Serous Pigment Epithelial Detachments and Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2654.
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To determine (1) whether morphology of neovascularization on indocyanine green angiography (ICGA) predicts response to anti-vascular endothelial growth factor (VEGF) therapy in eyes with serous pigment epithelial detachments (SPEDs) and age-related macular degeneration (AMD); and (2) whether ICGA-directed photodynamic therapy (PDT) is effective in decreasing disease activity in eyes with limited response to anti-VEGF monotherapy.
Retrospective analysis of patients with SPEDs and AMD between August 1, 2005 and November 15, 2010 who underwent intravitreal anti-VEGF induction therapy (3-5 consecutive monthly injections) and had ICGA. Disease activity was assessed by optical coherence tomography (OCT) and fluorescein angiography (FA) before and after therapy.
Search of the Duke Enterprise Data Unified Content Explorer (DEDUCE) Database and subsequent review of the medical record identified 38 eyes of 38 patients with SPED and AMD who had ICGA and who underwent anti-VEGF induction therapy. Of the 24 eyes who underwent induction at Duke (14 eyes had prior induction elsewhere), we found that arteriolarized vascular complex (AVC) (28%) and polypoidal choroidal vasculopathy (PCV) (32%) subtypes on pretreatment ICGA predicted persistent disease activity (unresolved PED, intraretinal fluid, subretinal fluid on OCT; unresolved PED lesion and leakage on FA; or new hemorrhage) after induction therapy. In contrast, capillary or mixed capillary/arteriole on pretreatment ICGA in our series (8%) and in a distinct dataset of NVAMD eyes (n=8) predicted decreased or often resolved disease activity after induction therapy. Of all 38 eyes that underwent induction, there was a strong correlation between persistent disease activity after induction and phenotypes of AVC or PCV on post-induction ICGA. In total, 18 eyes with persistent disease activity underwent ICGA-directed PDT in combination with anti-VEGF treatment (PDT combotherapy), while 11 eyes with persistent disease activity underwent continued anti-VEGF monotherapy. Comparison of the two groups was limited by selection bias. However, eyes undergoing PDT combotherapy had decreased disease activity by OCT and FA; the majority (n=5/6) of eyes with PCV phenotype had resolution of disease activity.
The majority of eyes with SPEDs and AMD have an identifiable neovascular subtype on ICGA, and the presence of AVC or PCV subtypes on pretreatment ICGA predicts persistent disease activity after anti-VEGF induction therapy. ICGA-directed PDT in combination with anti-VEGF therapy appears to be effective in decreasing disease activity in these eyes.
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