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Bradley S. Rosen, Daniel Sassoon; Pegaptanib Sodium and Modified FA Guided Scatter Laser for Macular Edema Secondary to Branch Retinal Vein Occlusion (BRVO): A Strategy to Reduce Retreatments. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1257.
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© ARVO (1962-2015); The Authors (2016-present)
Intravitreal pegaptanib administered every 4-6 weeks has provided improvements in visual acuity and central retinal thickness in a phase 2 study in patients with BRVO and in a non randomized clinical study. This case series evaluates the effectiveness of pegaptanib in combination with modified, FA guided scatter laser to treat macular edema secondary to retinal vascular occlusion in a clinical setting.
Retrospective analysis of consecutive patients with BRVO presenting to a single retina practice who were treated with intravitral injections of 0.3 mg pegaptanib sodium until normalization of the OCT, followed by FA guided scatter laser to areas of non perfusion or vascular abnormalities. Assessments included complete ocular examination, Snellen visual acuity (VA; converted to logMAR for analyses) and optical coherence tomography, as well as need for further intravitreal treatment after the initial 6 month treatment period.
Eleven eyes of 11 patients with BRVO received 5.54 intravitreal (range 4-13) injections of pegaptanib over a mean follow up period of 19.3 months (range 4-39 months). Eight (73%) were female and 5 (45%) had hypertension. The mean VA improved from logMAR values of 0.68 (≈20/96) at baseline to 0.28 (≈20/38) at last visits, and mean center point thickness decreased from 326 microns to 244 microns; gains of ≥3 and ≥0 lines of vision occurred in 45% and 82% patients, respectively, and 91% lost <3 lines during 6 months of follow-up. Ten of 11 patients achieved 20/50 or better final visual acuity, while only 3 of 11 patients required additional therapy after 6 months, to maintain visual gains.
In this small case series, promising visual and anatomical results were seen with pegaptanib in patients with BRVO. Results suggest that retreatments may be reduced with the addition of guided scatter laser therapy. Phase 3 trials are indicated to confirm the potential benefit of pegaptanib in patients with retinal vascular occlusion, and the role of adjunctive scatter laser in reducing the need for further intravitreal therapy.
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