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Richard Arceneaux, Frank Venzara, Martin L Thomley, Richard M Feist, Michael A Albert, John O Mason; Evaluation of Anti-VEGF Treatment in Peripapillary Neovascular Membranes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4933. doi: https://doi.org/.
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To review cases of patients with peripapillary neovascular membranes treated with anti-VEGF therapies and evaluate the use of anti-VEGF agents in treating this entity.
The charts of patients who received intravitreal injections with bevacizumab, ranibizumab, and aflibercept were retrospectively reviewed. Patients were included in the study if they were diagnosed with a new, previously untreated peripapillary neovascular membrane associated with sub-retinal or intra-retinal fluid confirmed by either OCT or by clinical ophthalmoscopy. Patients had to be followed for at least 4 months to be included in the study as well. Resolution of a lesion was defined by absence of intraretinal or subretinal fluid on clinical examination or by OCT. Recurrence of activity was determined by evidence of new subretinal or intraretinal fluid detected on clinical examination or OCT, or if any new hemorrhage was detected on clinical examination. Visual acuity and central retinal thickness were also assessed as outcome measures.
24 eyes from 22 patients met the inclusion criteria. 21 of 24 eyes were treated with bevacizumab alone and 3 other eyes were treated with other anti-VEGF agents. The average follow up time was 22.6 months and resolution occurred in 22 of 24 (91.6%) eyes after an average of 3.59 injections. 2 of 24 (8.3%) eyes had persistent sub-retinal fluid despite treatment. 9 of 22 resolved eyes had a recurrence at an average of 8.96 months after resolution, but 6 of these 9 became dry with continued treatment. Visual acuity was found to be stable throughout the treatment period with the exception of 1 patient with scar encroachment into the fovea. On average, central retinal thickness improved from 342 microns to 275 microns post treatment.
Peripapillary neovascular membranes are rare and previous studies have been limited to small case series with relatively short follow up times. In this study, patients treated with anti-VEGF therapy show a stabilization of visual acuity in both short and long term follow up, and anti-VEGF treatment also demonstrates a tendency to reduce sub-retinal fluid. No adverse events occurred with any of the 265 injections. In conclusion, it seems reasonable to use anti-VEGF therapy first line in the treatment of peripapillary neovascular membranes and larger, prospective studies would be helpful in continuing to evaluate their efficacy in treating these distinct entities.
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