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Yong Min Kim, Sung Jun Lee, Eun Jee Chung, Hyoung Jun Koh; Intravitreous Injection Of Antivascular Endothelial Growth Factor Combined With Injection Of Expansile Gas For Treatment Of Exudative Age-related Macular Degeneration With Posterior Vitreomacular Adhesion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1661.
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To evaluate the efficacy of intravitreous injection of anti-VEGF combined with injection of expansile gas for the treatment of exudative age-related macular degeneration (AMD) with vitreomacular adhesion (VMA).
This is a prospective, interventional, pilot case series. Four patients who had no response to the repeated anti-VEGF injections and had a definite VMA diagnosed with spectral domain optical coherence tomography (SD-OCT) were enrolled. Those patients underwent intravitreous perfluoropropane (C3F8) injection, followed by anti-VEGF injection simultaneously. Complete ophthalmological examinations, including corrected visual acuity, slit-lamp biomicroscopic examination, funduscopic examination and SD-OCT were performed.
Induction of posterior vitreous detachment (PVD) at the macula was achieved in all 4 patients within a month. Three patients had received mean 6.3±3.5 intravitreous anti-VEGF injections, but no response of treatment was observed with active lesion based on SD-OCT examination. After injection of expansile gas with anti-VEGF, the macula became inactive without any intraretinal cyst or subretinal fluid within three months. The elevation of intraocular pressure was not noted after that procedure. The frequency of additional injection was 1.6±1.0 during that period. The mean follow-up period after gas injection was 5.2±2.9 months.
An intravitreous injection of the inert C3F8 gas seems to be useful in that it induces PVD safely without change in the clearance of anti-VEGF. Further investigation involving a larger population with an appropriate control group is necessary to ascertain the efficacy of this combined treatment.
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