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K. Atmani, F. Coscas, G. Coscas, G. Soubrane; Pegaptanib Sodium for Occult Choroidal Neovascularization (CNV) in Neovascular Age-Related Macular Degeneration (NV-AMD): A Prospective Case Series. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2677.
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To assess the early functional and morphologic effects of pegaptanib for the treatment of subfoveal occult CNV in NV-AMD patients enrolled in a compassionate use program in France.
Pegaptanib use was authorized for visual impairment in the second eye and in which usual care with thermal laser photocoagulation or photodynamic therapy (PDT) verteporfin was not a reasonable alternative or contraindicated. Patients with occult CNV lesions with or without an associated clinical retinal pigment epithelial detachment (PED) or chorioretinal anastomosis (CRA) received intravitreous pegaptanib 0.3 mg every 6 weeks. Follow-up through 52 weeks included repeated ophthalmic examinations, color fundus photography, fluorescein angiography, scanning laser ophthalmoscopy-indocyanine green angiography, and optical coherence tomography. Morphologic changes were correlated with visual acuity (VA) results.
Fifty-six eyes with occult CNV lesions characterized as predominantly occult (N=22), pure occult (N=8), occult with CRA (N=12), or PED (N=14) were enrolled and all received 8 pegaptanib injections. 30% had prior PDT treatment. At week 52, 79% of patients were considered to be stabilized (lost <15 letters of visual acuity), 43% gained ≥0 letters, and 9% gained ≥15 letters. The best functional results were obtained in predominantly and pure occult subgroups (stabilized, 86% and 75%; gained ≥0 letters, 50% and 50%). In 82% of eyes with predominantly occult lesions, morphologic improvements (i.e., decreased leakage, regression of early phase network, decreased retinal thickness) were observed. Maximum visual outcomes that correlated with morphologic improvements on each diagnostic imaging tool were seen after at least 3 injections. No significant ocular or systemic adverse events occurred.
Treatment with pegaptanib is associated with VA improvements that can be correlated with objective clinical improvements on routine diagnostic imaging tool in patients with occult NV-AMD. Optimum treatment results appear after at least 4 months of therapy in the majority of cases.
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