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D. S. Dyer; Pegaptanib Maintenance in Neovascular Age-Related Macular Degeneration (NV-AMD) Following Induction Therapy: Results of a Retrospective Case Series. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1914.
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To assess the safety and efficacy of an induction/maintenance regimen involving the sequential administration of nonselective and selective anti-vascular endothelial growth factor (VEGF) therapies in achieving and maintaining a fluid-free retina and visual acuity (VA) gains in patients with NV-AMD.
A retrospective chart review of consecutively treated cases of NV-AMD with an anti-VEGF induction/maintenance regimen. Patients received intense induction therapy with non-selective anti-VEGF therapy, either intravitreal ranibizumab or bevacizumab, until no leakage was seen on fluorescein angiography and/or no fluid on optical coherence tomography. Intravitreal pegaptanib 0.3 mg was administered every 6 weeks with booster treatments of ranibizumab or bevacizumab at the investigator’s discretion for worsening NV-AMD.
In total, 132 eyes of all angiographic subtypes were followed for ≥12 months. Mean baseline VA improved from 20/138 to 20/121 with a mean of 3.5 induction injections. With pegaptanib maintenance, at 12 months, mean VA was 20/103; VA was maintained or improved in 72% of patients with 32% gaining ≥3 lines of VA and 93% losing <3 lines. Booster injections were required in 15 (11%) patients. Fifty-five eyes followed for ≥24 months had received a mean of 3.7 induction injections. Mean VA was 20/135 at baseline and 20/132 postinduction. With pegaptanib maintenance therapy, VA remained stable, with a mean at 24 months of 20/118; VA was maintained or improved in 67% of patients with 30% gaining ≥3 lines and 89% losing <3 lines. Booster injections were required in 7 (13%) patients.
A regimen involving an initial induction phase with non-selective anti-VEGF agents to eliminate retinal edema, followed by maintenance therapy with pegaptanib, was effective in improving and maintaining VA in patients with NV-AMD. Treatment results in a larger cohort of patients at 24 months will be presented.
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