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H. M. Petersen, A. R. Wenkstern, U. P. Genth; Visual Acuity and Anatomic Changes in Untreated Fellow Eyes With AMD After Anti-VEGF Therapy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):336.
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To assess anatomic changes in untreated fellow eyes with various stages of AMD and visual acuity (VA) improvement after anti-VEGF therapy for wet AMD in the better seeing eye.
In this retrospective case series, 19 patients with subfoveal CNV due to AMD were treated with either intravitreal injections of bevacizumab every 6 weeks and/or with ranibizumab every 4 weeks (average 3.4 injections, 1-8). Patients with VA improvement in their untreated fellow eye also suffering from various stages of AMD were identified and anatomical changes in these eyes were assessed using the following criteria: change in area of soft drusen by red-free fundus images, change in area of leakage by fluorescein angiography, and change in retinal thickness by OCT.
3 patients were treated in both eyes and 16 patients in one eye only. In 10 of these 16 patients, the fellow eye had no VA loss due to AMD and in 6 patients the fellow eye had VA loss due to AMD. The mean age of these 6 patients was 82 (69-94) years and baseline VA in the untreated worse eye was 26 (2-66) ETDRS letters. After a mean follow-up of 7 (2-14) months, VA improved by 53 (35 to 85) letters in 3 patients and remained stable (+/-0 letter change) in the other 3 patients. In the 3 patients with VA improvement in the untreated eye the area of soft drusen decreased, the area of leakage decreased and retinal thickness decreased significantly. No safety issues were identified.
Anti-VEGF therapy may improve the course of AMD in the untreated worse fellow eye. The 3 patients without VA improvement showed either geographic atrophy or inactive scar formation. As a possible mechanism, the distribution of the drug via blood circulation to the untreated eye can be discussed though only low blood concentrations of the drug can be usually measured after intravitreal injection. Detailed assessment of patients history is mandatory to exclude patients at risk for vascular side effects from the treatment. Further studies are warranted to investigate the effect of anti-VEGF therapy in eyes with soft drusen or late wet stage of AMD.
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