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Enrico Peiretti, Michela Vinci, Flavio Paolucci, Maurizio Fossarello; Anti VEGF and Photodynamic Therapy of Retinal Pigment Epithelial Detachments in AMD. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5150.
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To describe the different response to anti VEGF and photodynamic therapy of patients, affected by age- related macular degeneration (AMD), with retinal pigment epithelium detachment (RPED) with or without CNV, on the basis of best-corrected visual acuity (BCVA) and OCT.
18 eyes of 14 patients (mean age 69.3 years), with different type of RPED with or without CNV were treated with intravitreal injection (IVT) of an anti-VEGF (bevacizumab, or ranibizumab). All eyes received at least one intravitreal injection of anti-VEGF. OCT, fluorescein, indocyanine green angiography and BCVA were performed at the baseline and during follow-up and OCT measurement was taken in the higher part of the detachment at each control. When IVT treatment was not effective, patients were treated in a second step with IVT plus PDT. Patients were followed for a minimum follow-up of 1 year.
In our series, 9 eyes (50%) with PED were classified as having a plaque CNV (PPED), 5 eyes (27,7%) presented a RPED associated with focal CNV (FPED), and 4 eyes (22,3%) showed a drusenoid PED (DPED). The 9 eyes with PPED who received IVT, 66,6% improved BCVA and 33,3% were unchanged at the end of follow up. The 4 eyes with DPED all improved BCVA after IVT treatment. The 5 (27,7%) eyes with FPED were treated with at least one IVT, but none of the eyes improved in term of visual acuity. PDT was then applied in combination with IVT to the 5 eyes with FPED and at the end of the follow-up, visual acuity improved in 4 eyes (80%) and stabilized in one eye. Every eye with PED, showed variation in the OCT measurement between baseline and final follow-up.
On the basis of our preliminary results, we suggest that anti-VEGF therapy alone represents an effective treatment in eyes with DPED and with PPED, while FPED seems to require a combination of anti-VEGF and PDT therapy .
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