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D. F. Kiernan, S. M. Hariprasad, A. Praley, D. A. Mazzulla, W. F. Mieler; Intravitreally Injected Anti-VEGF Drugs Exert an Effect on Visual Acuity in the Fellow Eye. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4938.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether the intravitreal injection of the anti-VEGF drugs such as Macugen (Pegaptanib) or Lucentis (ranibizumab) exert any effect on visual acuity (VA) in the fellow eyes of patients with exudative age related macular degeneration (AMD) in at least one eye.
A retrospective chart review was performed of 45 injections (28 patients) receiving intravitreal Macugen or Lucentis between January 2004 and November 2006. Analysis included diagnosis, pre-injection VA and VA at follow-up (<6 weeks) of both the injected and fellow eyes. For statistical analysis Snellen VA was converted into ogarithm of the minimum angle of resolution (logMAR) VA. Statistical analysis was performed using a one-tailed student t-test.
All patients had a diagnosis of exudative AMD in their treated eye and either exudative or dry AMD in the fellow eye. In patients who received Lucentis, the mean pre-injection logMAR VA in the treated eye was 0.905 and the mean post injection logMAR VA was 0.894 (p=0.37). The mean pre-injection logMAR VA in the fellow eye was 1.34 and the mean post-injection logMAR VA was 1.26 (p= 0.27). In patients who received Macugen, the mean pre-injection logMAR VA in the treated eye was 0.769 and the mean post injection logMAR VA was 0.735 (p=0.28). The mean pre-injection logMAR VA in the fellow eye was 0.47 and the mean post-injection logMAR VA was 0.34. This difference was statistically significant (p= 0.04). In these patients, fellow eyes with exudative AMD (n=10) had a mean logMAR decrease of 0.24 (p=0.09). Fellow eyes with dry AMD (n=11) had a mean logMAR decrease of 0.07 (p=0.08).
Patients who received Lucentis had a greater decrease in mean logMAR VA in the treated eye than the fellow eye, though this difference was not statistically significant. Paradoxically, the effect of Macugen on decreasing mean logMAR VA in the fellow eye was significantly more prominent than the injected eye. Patients with bilateral exudative AMD showed more improvement in logMAR VA compared to patients with dry disease in the fellow eye indicating a trend toward visual improvement in both eyes after Macugen treatment. The mechanism of action of visual improvement in the fellow eye of patients receiving anti-VEGF therapy has not been clearly elucidated.
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