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D. R. Fintak, J. Ehlers, O. Gupta, A. Ho, C. Regillo, J. Vander, M. Fineman, R. Kaiser, J. A. McNamara, G. Brown; Pegaptanib for Large and Small Lesions in Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):97.
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To evaluate intravitreal pegaptanib in the treatment of choroidal neovascular membranes associated with exudative age-related macular degeneration (AMD).
This is a retrospective case study involving four clinical sites. Included were patients with exudative AMD treated with pegaptanib from 2/05 to 10/06. All patients were naïve to any treatment for AMD. Additional inclusion criteria included Va ≥ 20/400 at the time of first injection, and a minimum of 3 injections. The small lesion subgroup included patients with lesions ≤ 4 disc areas (DA). All patients had fluorescein angiography and visual acuities(Va) documented prior to treatment, and visual acuity measurements on subsequent follow-up visits. The primary outcome was change in visual acuity, as measured by standard office-based Snellen acuity charts. All adverse events occurring during the study period were also recorded.
When all lesions were considered, 111 eyes of 111 patients were included. The average Va at first treatment was 20/100. The average lesion size was 3.3 disc areas, with 92% being occult. The average line change in Snellen acuity was -2.9 at last follow-up. 41% of patients lost > 3 lines. 14% gained more than 3 lines and 10% maintained greater or equal to 20/40 vision. 43% of patients were switched to an alternate VEGF inhibitor. Average follow-up was 31 weeks, with an average of 4.8 injections. Sixty-six eyes of 66 patients had small lesions (≤4 DA) with an average Va at first treatment of 20/94. The average lesion size was 1.8 disc areas, with 92% being occult lesions. The average change in vision was a loss of 2.0 lines. 62% of patients maintained or improved their pretreatment vision. 15% and 11% gained more than 3 lines and had greater or equal to 20/40 vision, resepectively. Average follow-up was 29 weeks, with an average of 4.7 injections. There were 5 adverse events recorded during the study: 4 intraocular (subretinal hemorrhage, vitreous hemorrhage, and RPE rip) and 1 systemic (TIA followed by an MI after being switched to bevacizumab).
Pegaptanib provided a treatment alternative that maintained or improved vision in the majority of patients, with 14-15% gaining > 3 lines of vision. With the advent of multiple VEGF inhibitors, it will be important for future studies to help individualize treatment regimens for patients with exudative AMD.
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