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C. J. Beck, K. A. Darden; Pegaptanib Sodium for Clinically Significant Diabetic Macular Edema in Poor Candidates for Standard Transpupil Focal/Grid Photocoagulation: Results of a Retrospective Case Series. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4228.
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To assess anatomic and functional outcomes after intravitreal selective vascular endothelial growth factor (VEGF) inhibition in eyes with clinically significant diabetic macular edema (DME) harboring foveal avascular zone enlargement and/or central microaneurysms ineligible for standard laser per Early Treatment Diabetic Retinopathy Study (ETDRS).
Retrospective chart review of patients diagnosed with clinically significant DME not treated by standard transpupil focal/grid photocoagulation within preceeding one year. Selected cases featured angiographically enlarged foveal avascular zone and/or patent microaneurysms located at the foveal avascular margin. Assesments included visual acuity (VA), central subfield thickness (CST) analysis by spectral domain optical coherence tomography, and fluorescein angiography. All clinical examinations were conducted by a single retinologist (CJB) and all intravitreal injections were performed by a single, separate provider (KAD).
To date, 10 eyes of 10 patients ages 40-82 years with DME received a mean of 1.7±0.7 intravitreal injections of pegaptanib over a course of 4.5+1.6 months (range: 2-7). Mean VA decreased from 0.3±0.3 to 0.1±0.2 LogMAR. The baseline VA was maintained in 80% of treated eyes with 40% gaining ≥3 lines VA and 90% losing <3 lines. No eyes required adjunctive rescue therapy via standard transpupil focal/grid photocoagulation and/or nonselective VEGF inhibitor Rx and/or intraocular corticosteroid Rx. Mean CST increased from 259±46 microns to 275±55 microns. This delta was not statistically significant (paired t-test: p=0.22).
Short-term outcomes suggest intravitreal pegaptanib not only maintains but improves VA in eyes with clinically significant DME which are not ideal candidates for standard laser therapy. An apparent disconnect between functional and anatomical trends does not negate the positive results shown. Longer follow-up data will be presented.
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