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R. Margolis, R. P. Singh, P. K. Kaiser; Intravitreal Bevacizumab Treatment of Retinal Pigment Epithelial Detachment Due to Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4560.
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To evaluate the effect of intravitreal bevacizumab treatment on pigment epithelial detachment (PED) due to neovascular age-related macular degeneration (AMD), and to identify prognostic factors for regression of PED and improvement in visual acuity.
Twenty-one patients (21 eyes) with active CNV from neovascular AMD with PED were identified from a retrospective chart review from November, 2005 to July, 2006. A cohort of 25 AMD patients with CNV without PED was chosen randomly for comparison of change in retinal thickness in response to treatment. All patients received 3 intravitreal injections of bevacizumab (1.25 mg) during a 3 month period. Patients were examined at baseline and after each treatment using optical coherence tomography (OCT). Maximal PED height and area were analyzed using Image J software. Minimal retinal thickness was measured by calipers using the OCT software. Changes in PED dimensions were correlated with changes in retinal thickness and visual acuity.
Mean baseline visual acuity in eyes with PED was 20/143, and the mean visual acuity of non-PED eyes was 20/168. Baseline mean minimal retinal thickness in PED eyes was 901 microns, and baseline mean minimal retinal thickness in non-PED eyes was 577 microns. The average baseline PED area was 400.9 microns. PED eyes experienced a decline of 25.4% in total retinal thickness after one injection, and a total decline of 26.4% after three injections. In comparison, non-PED eyes experienced a decline of 26.9% after one injection and 33.5% after three injections. PED area decreased by 32.3% after one injection, and by 35.5% after three injections. After three treatments, 83% of eyes retained a PED. Visual acuity after 3 treatments was 20/149 in PED eyes and 20/146 in non-PED eyes. Initial PED size was correlated to poorer anatomical and visual response.
Intravitreal bevacizumab treatment was associated with a modest decrease in PED dimensions in patients with neovascular AMD. In a majority of patients, PED persisted despite repeated treatments with intravitreal bevacizumab. Initial PED size was found to be a negative predictive factor for treatment response and visual outcome.
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