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Jonah Abraham, Michael Elman; Development of Choroidal Neovascularization in the Second Eye of Neovascular AMD Patients Treated with Anti-VEGF Drugs. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4156. doi: https://doi.org/.
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The purpose of this study was to determine the risk and presentation of choroidal neovascularization developing in the second eye of patients undergoing regular anti-VEGF treatment for neovascular AMD.
This retrospective study reviewed the charts of all AMD patients treated in our center with anti-VEGF drugs for choroidal neovascularization between 2005-2012. Eyes that had undergone other treatments (PDT, laser) previously were excluded. At each visit after commencement of treatment in the first eye, both eyes were examined clinically as well as photographically (OCT and/or fluorescein angiography). The cumulative risk of developing neovascularization in the second eye, best available visual acuity and the presence of symptoms at the time of identification of neovascularization in the second eye are reported.
Four hundred thirty patients were identified with neovascular AMD in the first eye requiring anti-VEGF treatment. The mean interval between visits was 4.5 weeks. Eighty three patients developed neovascularization in the second eye requiring treatment. Life table analysis showed that 9% of fellow eyes developed neovascularization annually. The mean visual acuity at the time neovascularization was diagnosed in the second eye declined by one line from the preceding visit. The median visual acuity in the second eye at the time treatment was started was 20/50. Treated second eyes maintained an average visual acuity of 20/50 over followup. Only four of eighty three patients (4.8%) presented with symptoms at the time of diagnosis of neovascularization in the second eye.
The risk for progression to neovascularization in the second eye is high when the first eye is undergoing regular anti-VEGF treatment. Most patients are asymptomatic at the time of diagnosis in the second eye. Therefore, careful examination of the fellow eye should be performed at each visit in patients undergoing anti-VEGF treatment to the first eye and facilitates early detection of treatable neovascularization in the second eye while the vision is still quite functional.
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