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L. F. Mendonca, M. Falcao, S. Fonseca, E. Brandao, F. Falcao-Reis, A. Carneiro; Characterization of Patients With Neovascular AMD That Had Opposing Responses to Intravitreal Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):909.
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To describe and compare the characteristics of patients with Neovascular AMD that gained or lost visual acuity while under intravitreal Anti-VEGF therapy
Retrospective analysis of consecutive patients with Neovascular AMD that gained ≥15 letters (Group I), and that lost ≥15 (Group II), while in treatment with either intravitreal bevacizumab or ranibizumab on a 1+PRN regime for a period greater than 3 months. Baseline visit included ETDRS best-corrected visual acuity (BCVA), OCT and fluorescein angiography (FA). Treated patients were scheduled for re-evaluation 30±7 days after the injection with BCVA, OCT and, whenever deemed necessary, FA. When indicated, re-injection was performed 3-7 days after the follow-up visit. Patients without re-treatment criteria were re-observed monthly for evidence of disease activity.
51 eyes of 50 patients were included in Group I, and 34 eyes of 33 patients in Group II. Group I was significantly younger than Group II (75.41 vs 79.26 years; p=.018), while mean initial BCVA was significantly higher in Group II (I:29.1 vs II:50.1 letters; p<.001). During follow-up, only patients that lost VA developed fibrosis (20.6%; p=.001 vs I). The development of new hemorrhages (p=.337), and central atrophy (p=.770) was not different between groups, neither were the proportion of patients treated with either ranibizumab (I:43.1% vs II:38.2%) or bevacizumab (I: 56.9% vs II: 61.8%) (p=.653), the mean number of injections performed per eye (I:8.2 vs II:7.2; p=.376), and the history of previous PDT (I:15.7% vs II:14.7%; p=.902).
The functional outcome of anti-VEGF therapy appears to be better in younger patients. The evolution towards fibrosis while under treatment negatively influences visual prognosis. Larger studies are needed to clarify the relationship between some clinical characteristics and the response to anti-VEGF therapy.
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