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Y. B. Unver, S. H. Sinclair, W. Li, P. Presti; The Effect on High Contrast, Discriminated Target Visual Fields of Avastin Monotherapy for Cnvm Due to Amd. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2680.
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© ARVO (1962-2015); The Authors (2016-present)
Vision outcomes for treatment of AMD CNVM have been previously evaluated using visual acuity with severe limitations. Central visual field testing with discriminated targets appears to offer significant advantages. This pilot study evaluated short term outcomes of Avastin on CNVM due to AMD.
A retrospective review was conducted of eyes that underwent Avastin monotherapy at 6 week intervals for a minimum of three treatments and were evaluated prior to and 3 months following the last treatment with IVFA, OCT, best corrected VA by ETDRS, and testing of central 10o radius visual fields with high contrast discriminated targets (MAVES interactive computer program). Photographs and angiograms were assessed for CNVM type and graded for severity of leakage, fibrosis, and RPE atrophy. OCT was evaluated for central retinal thickness, presence of subretinal fluid, and height and width of PED. Correlations were drawn between these and visual field alterations.
Among the 50 eyes that were reviewed, 20 had treatment with PDT and intravitreal triamcinolone or Macugen prior to the Avastin. Thirty-six eyes demonstrated complete involution with minimal or no residual leakage after at least 3 courses of Avastin but with variable fibrosis and RPE atrophy. In 14 eyes there was minimal or no response. Overall, best corrected visual acuity improved by 4.5 letters (0.08 logMAR), but among the 36 eyes with complete or partial regression, VA improved by 0.10 logMAR compared with 0.04 logMAR in those with a poor response. MAVE central acuity (best acuity within 6 degrees radius of fixation) among all the eyes did not improve (0.02 logMAR) but in those that responded to treatment, it improved 0.08 logMAR compared to losing an average 0.06 logMAR in those eyes that did not respond. MAVE global acuity (weighted average of threshold acuities across all intercepts) in the 36 eyes that responded, improved by 0.08 logMAR and lost 0.1 logMAR among those not responding. DTCF scotoma size or density was inversely associated with severity and area of RPE atrophy, residual exudates or hemorrhage, and the severity and area of fibrosis.
In this small pilot study of Avastin treatment of CNVM due to AMD, central visual field testing with discriminated targets appears to offer improved understanding of retinal pathology and resulting vision.
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