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Brooke L W Nesmith, Mark Sherman, Yoreh Barak, Shlomit Schaal; Treatment of obstructive sleep apnea with continuous positive airway pressure therapy improves functional and anatomical outcomes in exudative age related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3153.
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© ARVO (1962-2015); The Authors (2016-present)
To prospectively compare the functional and anatomical response to intravitreal bevacizumab in patients with exudative age related macular degeneration (AMD) between two groups of patients with obstructive sleep apnea (OSA) with and without treatment with continuous positive airway pressure therapy (CPAP).
Two groups of OSA patients were included: 18 untreated and 20 treated with CPAP therapy. Both groups were treated with repetitive intravitreal bevacizumab (1.25md/0.05cc) for exudative AMD. Anatomical and functional response to treatment with and without CPAP was assessed. Patients were followed for up to 200 weeks. Macular thickness was plotted against time to assess anatomical response. LogMAR visual acuity changes determined the functional effect of treatment. Total number and frequency of intravitreal injections administered was calculated.
Patients in the two treatment groups did not differ in age, gender, initial visual acuity, or initial central retinal thickness. Throughout the follow-up period, patients in the OSA CPAP treated group received 8±7 total injections while patients in the untreated OSA group received 16±4 injections (P<0.05). Statistically significant better visual acuity was achieved in the CPAP treated OSA group; LogMAR 0.3±0.24, as opposed to the untreated OSA group; LogMAR 0.7±0.41 (P<0.05). Central retinal thickness improved in the CPAP treated OSA group compared to the untreated OSA group: 358±95µ to 254±45µ and 350±75µ to 322±105µ respectively (P<0.05).
The response of exudative AMD to intra-vitreal pharmacotherapy with bevacizumab is enhanced by treating of the underlying OSA with CPAP. Treatment of OSA with CPAP yields a subsequent impressive anatomical response and functional improvement while requiring significantly less injections. Identifying and treating underlying OSA earlier in the management of patients with exudative AMD may yield better functional outcomes. Underlying sleep apnea should be suspected in AMD patients who do not respond to bevacizumab.
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