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K. J. Ramaiya, M. G. Grand, D. Joseph; Good Visual Acuity in the Setting of Submacular Fibrosis in Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):926.
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Submacular fibrosis has been considered a poor prognostic indicator for central visual acuity in exudative age related macular degeneration (AMD). The purpose of this study is to re-evaluate this hypothesis in the setting of patients managed with intravitreal anti-VEGF agents. Here we present a series of patients with relatively good visual acuity despite the presence of significant submacular fibrosis.
The medical records, color photos, fluorescein angiography (IVFA), and optical coherence tomography (OCT) data were reviewed in a series of eyes of patients diagnosed with exudative AMD that have been managed at the Barnes Retina Institute using anti-VEGF therapy.
Inclusion criteria for the study were met by 13 eyes of 10 patients, including 6 males, and 4 females. All patients were Caucasian. The mean age was 76.1 years (range, 61.1 years to 86.1 years). Mean follow up interval was 37 months (range, 22 to 48 months). All patients were deemed to have submacular fibrosis based on clinical examination, color photography, and IVFA. Spectral domain OCT data from these patients is also presented. The mean best corrected visual acuity of patients during the treatment period in this series was 20/34 (range 20/25 to 20/50).
The historical supposition that central visual acuity will be limited in AMD patients with submacular fibrosis despite intervention requires reconsideration in light of the introduction of intravitreal anti-VEGF agents. These data suggest that the abortion of anti-VEGF therapy in some patients with submacular fibrosis may result in undertreatment and poorer visual outcomes.
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