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D. Fahed, N. M. Jabbour; Induction and Maintenance of Vascular Closure of Choroidal Neovascular Membranes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4585.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the ability of various treatments to induce vascular closure of choroidal neovascular membranes (CNVM) in age-related macular degeneration (AMD).
Sixty (60) consecutive cases of AMD with CNVM that were treated with intravitreal Avastin (IVA) alone, intravitreal Lucentis (IVL) alone, photodynamic therapy (PDT) alone, or PDT followed by IVA or IVL, were evaluated by fluorescein angiography for neovascular activity, 3,5,7,14,30,60 & 90 days following treatment.
On the 3rd and 5th days following PDT, a round hypofluorescent disc was noted (corresponding to the size of the applied treatment spot). The disc represented vascular closure in the CNVM as well as the surrounding (otherwise normal) choriocapillary bed. Between the 7th and 14th day post-op, the CNVM remained closed, while the normal choriocapillaries reopened. Between the 30th and the 60th day post-op, 85% of the CNVM started showing FA signs of reopening. Eyes treated with IVA or IVL alone showed decrease in CNVM hyperfluorescence, but no complete obliteration. The decrease in hyperfluorescence was commensurate with decrease in thickness noted on OCT and with improved visual acuity. In 93% of these cases the degree of hyperfluorescence was practically back to baseline level on the 30th day post-op. These findings remained constant with one, two or three consecutive injections. However, IVA & IVL following PDT maintained the closure of the CNVM up to at least 90 days in 70% of cases.
PDT but not intravitreal anti-VEGF induces vascular closure. However, IVL and IVA can maintain closure once established by PDT.
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