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I. Kozak, F. Mojana, V. L. Morrison, D.-U. Bartsch, W. R. Freeman; Autofluorescence Imaging in Exudative Age-Related Macular Degeneration After Anti-VEGF Treatment. Invest. Ophthalmol. Vis. Sci. 2008;49(13):264. doi: https://doi.org/.
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To determine if fundus autofluorescence (AF) can predict treatment response to anti-angiogenic agents in exudative age-related macular degeneration (AMD).
A prospective cohort study. We reviewed the visual acuity results, fundus AF and fluorescein angiography (FA) in 41 eyes of 39 patients with subfoveal AMD who were treated with anti-angiogenic therapy. The patients were treated with pegaptanib sodium followed by bevacizumab (n=2), ranibizumab followed by bevacizumab (n=4) and bevacizumab monotherapy (n=35) for a period of a minimum of six months. For FA and AF, we used a confocal scanning ophthalmoscope (Heidelberg Retina Angiograph 2; Heidelberg Engineering GmbH, Dossenheim, Germany) with a 488 nm excitation light and a 500 nm barrier filter with a 30ºx30º field of view. The main predictor was presence or absence of intact fundus AF and the main outcome was the proportion of eyes with a three lines improvement of ETDRS vision six months after treatment. Main outcome measures were visual acuity measured using EDTRS charts and intact/non-intact fundus AF patterns.
The baseline for both the mean and median visual acuity (VA) in the group was 0.8 (logMAR). After 6 months, the mean and median VA’s in the group were 0.7 (logMAR) and 0.8 (logMAR), respectively (p=0.048). Presence of intact AF at the fovea prior to treatment was associated with better VA (p=0.001). The proportion of eyes with an improvement of VA by 3 or more ETDRS lines was higher in eyes with intact foveal AF versus a non-intact foveal AF (p=0.05). After treatment, there was a significant normalization in the AF pattern outside the fovea (p=0.02), particularly in eyes with VA improvement.
The eyes with subfoveal exudative AMD presenting with intact foveal AF are more likely to have a better treatment outcome with anti-angiogenic therapy than eyes with exudative AMD and a disturbed AF in the fovea. Fundus AF is thus an important predictor of visual improvement.
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