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J. Hedaya, N. Nigam, W. R. Freeman; Intravitreal Avastin Treatment in Poor Prognosis Patients With Chronic, Disciform Age-Related Macular Degeneration (ARMD). Invest. Ophthalmol. Vis. Sci. 2008;49(13):313.
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To evaluate the visual acuity and anatomical outcomes in patients with chronic ARMD and a significant disciform component who received monthly intravitreal avastin injections.
Twelve consecutive patients with longstanding, chronic ARMD were enrolled. All patients had subretinal and/or intraretinal serous fluid evident on optical coherence tomography (OCT) with a significant component of subfoveal fibrotic scarring. Seven of these eyes had received prior therapy without a good result and all had disease over 2 years. Patients were given monthly intravitreal avastin injections until resolution of fluid on OCT was achieved or until the study endpoint of 7 injections had been reached. Two-meter ETDRS visual acuities were obtained at every visit, and OCT data was obtained at every other monthly visit.
The mean OCT retinal thickness change following treatment was -210µ (range -531 to +116). The mean change in ETDRS vision was +0.3 letters in patients that had a decrease in OCT retinal thickness following treatment. The mean change was -0.3 letters in patients that had an increase in OCT retinal thickness following treatment. Only 2 of the 12 eyes gained one line or more (7 and 11 letters). Following treatment, the mean change was 0.1 letters on ETDRS visual acuity testing (range +11 to -11).
Treatment of longstanding, chronic ARMD with avastin results in a statistically significant decrease in central retinal thickness on OCT (p = 0.0023). However, this does not result in any visual acuity gain on average, and there were no obvious predictors of visual acuity gain in patients that responded. Since the natural history of wet ARMD is progressive visual acuity loss, we cannot say whether treatment with avastin might actually retard visual acuity loss in advanced disease. Further study to investigate this possibility may be warranted, however, once choroidal neovascularization is long standing and subretinal fibrosis occurs, treatment with avastin, even if it reduces fluid, is not associated with clinically meaningful vision improvement.
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