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Guillermo Fernandez Sanz, Rafael Alonso-Gonzalez, Pearse Keane, Ester Carreno, Gerald Liew, Dawn Sim, Praveen Patel, Andrew Webster, Catherine Egan, Adnan Tufail; Treatment with Intravitreal Anti-VEGF for Choroidal Neovascular Membrane secondary to Sorsby's Fundus Dystrophy: A 24-Month Analysis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3863.
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To evaluate the safety and efficacy of 24-month intravitreal therapy with anti-vascular endothelial growth factor (VEGF), bevacizumab or ranibizumab, for treatment of choroidal neovascular membrane (CNV) secondary to Sorsby's fundus dystrophy.
All patients with bilateral CNV related to Sorsby's fundus dystrophy and treated with intravitreal anti-VEGF agents (bevacizumab/ranibizumab) at Moorfields Eye Hospital (May 2006 to October 2010) were included in this study. All affected patients were heterozygous for the p.Ser204Cys missense mutation in exon 5 of the TIMP3 gene. Best Corrected Visual Acuity (BCVA) was assessed at 1, 3, 6, 12, 18 and 24 months from treatment by Snellen chart with logMAR conversion. Significant visual loss was defined as an increase ≥0.3 logMAR units. Fellow eyes not treated with anti-VEGF agents were used as a control. Clinical data were retrieved from medical records. Cox-proportional-hazards regression was performed to investigate the associtation between anti-VEGF and significant visual loss.
A total of 9 eyes in 8 patients were treated with intravitreal anti-VEGFs, of whom 62.5 % were male . Mean age at diagnosis was 45.3±6.9 years(y) in the treatment group and 54.0±8.4y in the control group. Mean BCVA at baseline was 0.40±0.41 and 0.60±0.67 logMAR in control and treatment group respectively (p=0.60). Classic CNV was present in 5 eyes (55.6%) in the treatment group and the most common location for any CNV was juxtafoveal (6 eyes [66.7%]). Mean number of injections was 9.11±6.01, median 12 (interquartile range 2.5-14.5). After 6 months 7 (100%) eyes in the control group had significant visual loss while this occured in only 2 (22.2%) eyes in the treatment group after 24-months of treatment (p<0.001) (Figure1). Treatment with anti-VEGF significantly protected against significant visual loss (Hazard Ratio, HR=0.044, 95%CI [0.005-0.392]). No drug or injection related complications were observed during the follow-up.
Intravitreal anti-VEGF treatment for CNV related to Sorsby's disease is safe and effective. In these patients, the risk of developing significant visual loss is reduced by 96% at 24 months.
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