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Lucian V. Del Priore, Claudia Brue, Joseph J. Tseng, Jason S. Slakter, Richard F. Spaide, Gaetano R. Barile, K Bailey Freund; Spectral Domain OCT-based Detection and Treatment of Asymptomatic Subretinal or Intraretinal Fluid in the Second Eye of Patients with Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2011;52(14):157.
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Prior studies have shown that the fellow eyes of patients with unilateral neovascular age-related macular degeneration (AMD) are at high risk of converting to neovascular AMD. Spectral domain optical coherence tomography (SD-OCT) is a noninvasive, inexpensive, and sensitive imaging modality that can be used to screen the second eye of AMD patients for asymptomatic subretinal or intraretinal fluid. Herein we identify patients with asymptomatic exudation in their second eye detected using OCT-guided imaging, and we describe the results of treatment with intravitreal anti-VEGF therapy.
Retrospective chart review of patients who were detected to have asymptomatic subretinal or intraretinal fluid using spectral domain optical coherence tomography (SD-OCT).
We identified 28 eyes of 28 patients (17 males, mean age: 79.9 ± 6.9 years) with known neovascular AMD in one eye, in whom SD-OCT of the fellow eye detected asymptomatic subretinal or intraretinal fluid during one of their periodic follow-up visits. Initial best corrected visual acuity of these asymptomatic eyes ranged from 20/20 to 20/40. Occult neovascularization was present in all 12 eyes that underwent fluorescein angiography prior to treatment. All patients were treated with intravitreal anti-VEGF therapy (bevacizumab and/or ranibizumab) utilizing a variety of treatment regimens (monthly, 3 monthly injections followed by quarterly, "treat and extend" or SD-OCT-guided as needed). The average number of intravitreal injections in the second eye was 4.0 per eye over a mean follow-up of 43 months. There was a wide range in the number of injections received (range = 1 to 24 injections) due to the different treatment protocols. Final best corrected visual acuity ranged from 20/20 to 20/70.
Routine SD-OCT imaging of the fellow eye of high risk patients who have already exhibited neovascularization in their first eye allows for early detection of subretinal or intraretinal fluid in some patients prior to the onset of symptoms. Visual acuity results are excellent if treatment of asymptomatic fluid is initiated prior to the onset of significant visual loss. Larger clinical trials are necessary to determine the natural history of asymptomatic fluid, and to delineate the benefits and costs of SD-OCT based screening and subsequent early treatment.
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