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Simone Donati, Muna Al Oum, Marco Bianchi, Paolo Barosi, Alfredo Pece, Claudio Azzolini; Experimental Score Grading Scale For Anti VEGF Retreatment Decision In Exudative AMD. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5169.
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To create a score grading scale to improve and refine upon re-treatments choice with anti VEGF drugs in exudative AMD
We reviewed grading and retreatment parameters in published international clinical randomized studies for exudative AMD treatment with antiVEGF. We identified different criteria to evaluate the characteristics of the lesions and its evolutive behaviour. Clinical parameters included visual acuity, morphological characteristics like presence of pigment epithelium detachment and/or haemorrhages and quantitative parameters like lesion dimension (GLD) on fluorescein angiography and macular thickness on Spectral OCT. Based on experienced retinal physicians, we assigned a specific score for each criteria. We analysed a cohort of 87 patients affected by exudative AMD and treated with more than 3 injections of anti VEGF to test and calibrate our score.
First step on our study allowed us to identify mayor and minor parameters and their different weight on final score. Side by side to experienced retinal physicians, we assigned a definite value for each parameters. We compared the retreatment decision of a masked retinal physician to the total sum of different parameters value. The result allowed us to rectify each parameters to identify total edge value for three different categories: lesion active and retreatment, lesion inactive and no treatment but observe, lesion inactive and fibrotic and no treatment. On second step we verified the concordance of our score level to the retinal specialists decisions (85%) and the repeatability of the tool (99%).
This staging system represents a shared approach to standardize clinical evaluation and retreatment choice among ophthalmologists in exudative AMD. Our study experimentally underlined its clinical applicability and worth: further studies will be applied to verify different edge score and to identify good and non responders, for a costs and managing saving.
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