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L. J. Rao, V. C. Lima, R. C. Gentile, R. Rosen; Reduction of Macular Drusen Following Anti-VEGF Intravitreal Injection in ARMD. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1881.
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To report an observation and better characterize the finding of diminished macular drusen after intravitreal anti-VEGF therapy for choroidal neovascularization (CNV) in age related macular degeneration (ARMD).
After observing a case of diminished drusen after intravitreal anti-VEGF therapy, a retrospective photographic and chart review was conducted to identify similar cases from fundus photography performed before and after intravitreal anti-VEGF therapy for CNV in ARMD.
Six eyes of six patients were identified. There were four females and two males, with an average age of 74.5 years (range 64-87). Three patients received intravitreal bevacizumab injections, and three received ranibizumab. The mean number of injections was 5 (range 1-12). Drusen diminished in the area of choroidal neovascularization (CNV) without associated subretinal fibrosis. After treatment, visual acuity improved in two eyes, stayed the same in two eyes, and decreased in two eyes. The mean pre-treatment visual acuity was 20/50 (range 20/20-20/160) compared to 20/60 (range 20/20-20/160) after treatment. Three of the eyes had classic subfoveal CNV, one had occult CNV, and two had occult CNV with associated pigment epithelial detachments.
Diminished drusen can occur after the development of wet ARMD without subretinal fibrosis when treated with anti-VEGF intravitreal therapy. The loss of drusen occurs in the area of CNV and can be associated with both occult and classic CNV. The exact mechanism is not known but most likely may be related to vascular reabsorbtion and clearing of drusen debris during CNV regression and suppression.
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