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R. Ahmed, H. R. Shah, E. R. Holz, P. E. Carvounis; A Comparison of Baseline Lesion Characteristics Associated With Long-Term Response to Fewer Than 3 Intravitreal Anti-VEGF Injections. Invest. Ophthalmol. Vis. Sci. 2010;51(13):919.
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To compare the baseline lesion characteristics of patients with exudative age-related macular degeneration (ARMD) who showed a long-term response to fewer than 3 injections to those who required more than 3 injections of anti-vascular endothelial growth factor (VEGF).
Consecutive patients with exudative ARMD who received intravitreal bevacizumab or ranibizumab as primary treatment and lost 3 or fewer lines of vision over 18 months of follow-up were retrospectively reviewed. Injections were administered pro re nata (prn) for new retinal hemorrhage or for increasing or persistent subretinal or intraretinal fluid on optical coherence tomography or leakage on fluorescein angiography.
There were 7 eyes in the group receiving 3 or fewer injections (group F) and 19 eyes in the group receiving 3 or more injections (group M). There were no statistically significant differences between the two groups at baseline in terms of lesion size (p=0.13), lesion composition (occult versus classic, p=0.67), pigment epithelium detachment presence or absence (p=0.65), height of subretinal fluid (p=0.38), foveal thickness (p=0.07), or initial visual acuity (p=0.29). However, the eyes in group F compared to group M had a statistically significant greater improvement in visual acuity gain at 6, 12, and 18 months (p=0.001, p=0.002, p=0.001, respectively).
There were no lesion characteristics at baseline predictive of requiring fewer injections in an18 month period in a prn injection schedule of intravitreal ranibizumab or bevacizumab for exudative ARMD. Further studies are required to determine if patients with disease that is anti-VEGF sensitive have a different underlying disease pathogenesis not reflected in the initial observed lesion.
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