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M. S. Pezda, C. Kim, G. W. Abrams, T. H. Mahmoud; Effect of Vascular Endothelial Growth Factor (VEGF) Inhibitors in the Treatment of Peripapillary Choroidal Neovascularization (CNV). Invest. Ophthalmol. Vis. Sci. 2008;49(13):2678.
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To ascertain any potential benefit in the treatment of peripapillary CNV with intravitreal VEGF inhibitor injections.
A retrospective chart review was conducted of patients who underwent at least one intravitreal anti-VEGF injection for the treatment of active peripapillary CNV. Data was gathered from patient charts and digital images. Data included visual acuity, retinal thickness on optical coherence tomography (OCT), foveal involvement, lesion size including the presence of subretinal fluid, lipids, and/or hemorrhage, number and type of injections, and size of CNV lesions on fluorescein angiogram (FA) as well as areas of leakage. Comparison between baseline and final follow-up data was performed using the Wilcoxon signed rank test.
Eight patients with active peripapillary CNV lesions were identified. 4 were due to age-related macular degeneration (AMD), 2 due to angioid streaks, and 2 with idiopathic polypoidal choroidal vasculopathy (IPCV). Mean age was 78.0 years (57.2 to 90.7 years). There were 4 males and 4 females. Foveal involvement occurred in 6 cases. VEGF inhibitors included bevacizumab (Avastin), pegaptanib (Macugen), and/or ranibizumab (Lucentis). There was a mean of 4.5 injections per patient (1 to 10 injections). The mean interval between injections was 8.8 weeks (3 to 26 weeks). Mean follow-up was 12.2 months (5 to 24 months). Mean baseline Log-MAR visual acuity was 0.953 +/-0.534, corresponding to 20/200. On final follow-up this was 0.61 +/-0.505, corresponding to 20/80 (p-value 0.0630). Mean baseline foveal thickness of 233.4 +/-91.1 decreased on final follow-up to 218.4 +/-106.6 (p-value 0.6241). Mean baseline lesion size of 22.8 +/-20.9mm2 decreased on final follow-up to 12.3 +/-13.9mm2 (p-value 0.0117). Mean baseline FA leakage of 14.9 +/-14.6mm2 decreased on final follow-up to 8.0 +/-9.5mm2 (p-value 0.0117). Three patients received prior treatment, 2 of those were thermal laser 4 years prior to injection and 1 was photodynamic therapy 2 years prior. These patients showed stable visual acuity.
Anti-VEGF intravitreal injection monotherapy may be of value in the treatment of peripapillary CNV. The significant decrease in lesion size and area of leakage, not paralleling a significant improvement in visual acuity and OCT thickness, may be explained by other treatments received by some patients and chronicity of those lesions prior to the initiation of the anti-VEGF therapy.
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