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W. M. Stapleton, M. L. Mulhern, D. D. Ingvoldstad, A. A. Johansen, E. Margalit; A Comparative Study of Current Therapies for Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):592.
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To compare available FDA approved and unapproved (off-label) treatments for neovascular age-related macular degeneration (AMD).
A retrospective chart review study was performed to compare visual acuity, fluorescein angiography lesions’ type and size, retinal thickness measured by optical coherence tomography (OCT), and number of treatments among patients treated with intravitreal bevacizumab, intravitreal ranibizumab, intravitreal pegaptanib, focal laser photocoagulation, photodynamic therapy with verteporfin (PDT), and combined photodynamic therapy with verteporfin and intravitreal triamcinolone acetonide (TA).
A preliminary summary of our clinical data from patients with neovascular AMD showed 2 patients were treated with bevacizumab, 11 with ranibizumab, 4 with pegaptanib, 4 with focal laser, 18 with PDT and 11 with combined PDT and TA. Change in LogMar visual acuity from baseline (treatment start) to 1 year follow-up was, improved for ranibizumab (-0.0664 ±0.1110 LogMar units). However, 1 year follow-up visual acuity was worse for pegaptanib (+0.2083 ±0.1215 LogMar units), focal laser (+0.1683 ±0.1254 LogMar units), PDT (+0.2083 ±0.4484 LogMar units) and PDT with TA (+0.2593 ±0.4580 LogMar units). OCT showed reduction in retinal thickness for ranibizumab (-51 ±41.82 µm) at 3 month follow-up. Change in flourescein angiography (FA) lesion size at 3 months was smaller for ranibizumab (-0.6129 ±0.4499 mm3) and pegaptanib (-0.3513 ±1.2819 mm3). Flourescein angiography lesion size was larger at 3 months for PDT (0.0250 ±0.0250 mm3) and combined PDT and TA (0.4569 ±0.890 mm3).
Preliminary results from this retrospective study showed ranibizumab is likely the best choice for the treatment of neovascularization in AMD eyes, showing more favorable visual acuities, reduction in retinal thickening, and neovascular lesion size as measured on FA compared to other treatments. Final results are expected to include data from 100 additional AMD patients treated for choroidal neovascularization in our clinic.
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