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Fani Zacharaki, Manju Chandran, Narendran Nair, Priyanga Vijayakumar, Geeta Menon; Anatomic patterns and clinical presentation of recurrence in ‘stable’ wet Age Related Macular Degeneration (AMD) patients. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4088.
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To determine anatomic features and clinical presentation of recurrence in patients under anti-Vascular Endothelial Growth Factor (VEGF) treatment for wet AMD, who had an untreated observation period of more than 6 months.
We reviewed data of AMD patients on Ranibizumab treatment that had not had an injection for a period of at least 6 months, therefore characterized as ‘stable’. Only patients fulfilling the National Institute of Clinical Excellence (NICE) guidelines for treatment were included in the study. Stability criteria were: complete resolution of Intraretinal fluid (IRF) or Subretinal fluid (SRF), or existence of stable cysts of IRF. In our clinic these patients were still followed-up monthly. On each visit, they were asked to report any subjective changes in visual function and they underwent ocular examination including Best Corrected Visual Acuity (BCVA), macular Optical Coherence Tomography (OCT) using Heidelberg Spectralis, and dilated Fundus Biomicroscopy. Retreatment criteria were: SRF, IRF, or new intra- or subretinal haemorrhage.
75 eyes (66 patients, 46 female and 20 male) were reviewed that met stability criteria. Mean treatment-free period was 17 months (range 6-42 months). Mean number of previous injections was 6.8 (range 3-24). Twelve patients (16%) met the retreatment criteria and received an injection. Mean injection-free period for retreated patients was similar to the general group (mean 16.6 months, range 7-37). Three of the retreated patients (25%) reported visual distortion on that visit, and the majority (n=9) remained asymptomatic. In 5 patients a decrease in VA was documented, whereas 7 had stable VA compared with their last visit. In all 12 retreated cases, presence of fluid was documented in the OCT. 10 cases presented with new SRF, 1 case with new IRF and 1 with increased IRF. Only in 1 patient (8.3%) was there clinical evidence of recurrence on biomicroscopy (new macular haemorrhage).
With the increasing pressure of new and follow up patients in Medical Retina clinics, it has been suggested that extending follow up might be considered for 'stable' patients. Our data imply that anatomic changes usually precede functional deterioration in recurrences of wet AMD. This should be taken under consideration when a decision of further management of stable AMD patients is to be made.
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