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N. A. Chaudhry, V. A. Kon Jara, H. Tabandeh, W. F. Mieler, P. E. Liggett; Intravitreal Anti-VEGF Therapy for Exudative Age-Related Macular Degeneration in the Presence of Significant Macular Pucker. Invest. Ophthalmol. Vis. Sci. 2010;51(13):550.
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To evaluate the effect of significant macular pucker on the visual and anatomic outcomes of intravitreal anti-VEGF therapy for exudative age-related macular degeneration (ARMD).
We retrospectively reviewed all cases of active exudative ARMD with significant macular pucker treated with periodic intravitreal anti-VEGF therapy. Diabetic eyes were excluded.Snellen visual acuity and Optical coherence tomography (TD-OCT) were performed during each visit. Fluorescein angiography and intravitreal injection of 0.5 mg of Ranibizumab or 1.25 mg of Bevacizumab were administered whenever indicated. Outcome measures included visual acuity and central macular retinal thickness on OCT.
Eleven eyes of 10 patients were included in the study. Seven were male and 4 female with a mean age of 78.2 years. Visual outcomes were variable, 4 patients improved by three lines or more, 5 patients remained stable and 2 patients got worse. Complete resolution of subretinal fluid was seen but improvement in intraretinal edema and central retinal thickness were minimal. This later finding appeared to be secondary to the epiretinal membrane and may not be related to the activity of the choroidal neovascular membrane. Absence of leakage on FA was used in initiating drug-free interval. Macular pucker removal was not performed in any of the study eyes.
Intravitreal anti-VEGF therapy for exudative ARMD with concurrent macular pucker can result in successful anatomic stabilization. Visual outcomes are variable and appear to be partly limited by the concurrent epiretinal membrane. FA is valuable in detection of leakage when drug-free interval is being considered. Decision to perform macular pucker surgery in these patients is difficult and can theoretically impair the success of future anti-VEGF therapy for the exudative ARMD because of the shortened ocular half-life of the injected drug.
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