Abstract
Purpose::
Choroidal neovascularization (CNV) can arise in young patients secondary to myopic degeneration and idiopathic polypoidal vasculopathy among other causes. Anti-VEGF therapy is currently approved for treating only wet macular degeneration; however recent reports demonstrate its effectiveness in non-wet macular degeneration choroidal neovascularization, specifically pathologic myopia.We describe four cases of non-wet macular degenerative choroidal neovascularization treated successfully with intravitreal pegaptanib and adjunctive PDT.
Methods::
Four patients (three with myopic CNV, one with IPVC) were treated with intravitreal pegaptanib for CNV every six weeks. Three patients were initially treated adjunctively with PDT, 4 days following their intravitreal pegaptanib injection. Intravitreal injection was administered under controlled aseptic conditions, using sterile gloves, a sterile drape, and a sterile lid speculum. PDT was administered using standard protocols in a hospital setting. An ophthalmic examination, including measurement of VA, IOP, and anterior/posteroir segment examination, was performed at baseline, every 6 weeks before injection and 4-5 days after injection. Visual acuity was assessed with ETDRS charts pre and post treatment. OCT and FA were performed when indicated.
Results::
Follow up was from 18-30 weeks with an average of 26 weeks follow up. Patient ages ranged 34-44 years of age; of the three women and one man, the average age was 39.25 years of age. Average treatment per eye was 3 treatments, ranging from 2-4 treatments.The patients received pegaptanib and PDT initially and then continued intravitreal pegaptanib every 6 weeks. Visual improvement averaged of 40 letters at 30 weeks. Average baseline OCT, prior to the initiation of treatment, was 269 microns and decreased an average of 56 microns after the first injection. OCT thickness varied throughout the study period; average OCT at 30 weeks was 161, and the anatomic improvement correlated with visual improvement.
Conclusions::
The response of the healthier RPE-photoreceptor complex surrounding the lesion may help explain the excellent visual acuity improvement with intravitreal anti-VEGF treatments with adjunctive PDT in these younger patients compared to patients with AMD. Intravitreal anti-VEGF injections were well-tolerated in this population; however, further studies and longer follow-up are warranted to assess the long-term safety and efficacy of intravitreal anti-VEGF injections for the treatment as compared with other treatment modalities.
Keywords: choroid: neovascularization • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials