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K. Urban, P. A. Quiram, K. Drenser, A. Capone, Jr., T. S. Hassan, G. A. Williams; Recurrence of Active Choroidal Neovascularization Following Intravitreal Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1823.
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To evaluate the recurrence of active choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD) who had resolution of CNV after treatment with vascular endothelial growth factor (VEGF) inhibitors.
We conducted a retrospective chart review of patients who demonstrated clinical resolution of active CNV following intravitreal injections of anti-VEGF agents between April 2005 and December 2006 at one retinal referral center. Intravitreal injections were given approximately 4-6 weeks apart; treatment was discontinued when CNV lesions became inactive. Visual acuity, clinical examination, fluorescein angiography (FA), and optical coherence tomography (OCT) were reviewed for recurrence of CNV.
Fifty-four eyes of 49 patients (39% male, 61% female) with a mean age of 80.8 years (range 67-94 years) were included in this study. Fifteen (27.8%) of 54 eyes exhibited recurrence of subretinal fluid and/or subretinal hemorrhage after a period of CNV inactivation. Nine of these 15 eyes (60%) recurred after treatment with Avastin; six recurrences (40%) were observed after treatment with Macugen. On average, eyes treated with Macugen took longer to recur than those treated with Avastin (23.7 weeks and 13.3 weeks, respectively).
Targeted pharmacotherapy with anti-VEGF agents has expanded the treatment options for patients who develop neovascular AMD. To our knowledge, this is the first study to compare recurrence of CNV in the clinical use of multiple anti-VEGF agents. Rates of recurrence with these agents are substantial and suggest that sustained or pulsed VEGF suppression may be required. The present study emphasizes the fact that AMD is a chronic recurrent disease requiring regular follow up.
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