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G. P. Giuliari, Y. M. Morilla, D. A. Guel, N. R. Patel, V. H. Gonzalez; Vascular Remodeling After Intravitreal Pegaptanib in Ischemic Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2749.
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© ARVO (1962-2015); The Authors (2016-present)
To study the effect of intravitreal injections of pegaptanib sodium (Macugen) on areas of vascular abnormalities as assessed by fluorescein angiography (FA) in patients with proliferative diabetic retinopathy (PDR).
Retrospective chart analysis of 5 subjects with PDR treated with intravitreal pegaptanib from a private vitreo-retinal practice in South Texas (Valley Retina Institute P.A.). All of the subjects presented high risk PDR without prior treatment with PRP. One subject had received focal laser for clinically significant macular edema 6 months prior. All five patients received intravitreal pegaptanib. Three of the five patients received treatment every 6 weeks for a total of 6 injections. One patient received 2 injections 6 weeks apart. The remaining patient received 3 injections; the second was administered 3 months after the first, and the third was administered 6 months later after the second. Assessments included best-corrected visual acuity (BCVA), FA, fundus photographs, and clinical examination.
BCVA improved in 2 of the 5 subjects by week 3; the remaining subjects retained stable BCVA. There was a notable improvement in the appearance and the angiographic changes associated with diabetic retinopathy, such as vascular tortuosity, venous beading, and intraretinal microvascular anomalies (IRMAs) in all 5 patients after the first injection.
Treatment with selective blockade of vascular endothelial growth factor (VEGF) may potentially improve the vascular changes associated with severe non-proliferative diabetic retinopathy and early proliferative diabetic retinopathy. It may also have a beneficial effect on vision, as exhibited by the stabilization of BCVA in all 5 subjects presented here. Note that this is a very small sample and further study is needed to imply a relationship between vascular remodeling of the retina and treatment with Macugen. This data, however, opens a new and exciting chapter in the management of diabetic retinopathy.
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