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J. A. Mackiewicz, J. Dolar-Szczasny, Z. Zagórski; Autofluorescence Imaging After Intravitreal Bevacizumab Injections in Exudative Form of Age - Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3411.
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To evaluate the effects of treatment on fundus autofluorescence in patients with age-related macular degeneration and choroidal neovascularization (CNV) after bevacizumab intravitreal injections
33 eyes of 32 patients, aged 60- 86, with confirmed choroidal neovascularisation (CNV) and AMD were treated. Patients received form 1 to 5 intravitreal bevacizumab (1.25 mg) injections on 1-3 months basis. Fundus autofluorescence (FAF) images were obtained using a confocal scanning ophthalmoscope HRA2 (excitation 488nm, emission above 500nm). Autofluorescence images were compared with color fundus photographs, fundus fluorescein angiographic images and visual acuity results. FAF images together with fluorescein angiograms and color fundus photographs were performed before treatment and 1 month after each bevacizumab injection. Mean follow-up period was 9 months (from 3 to 15 months).
At baseline, autofluorescence was near normal in CNV area in 20 eyes (61%) and in 13 eyes (39%) showed mottled pattern or slightly decreased/increased signal in CNV area. Additionally an adjacent area of increased FAF significantly larger than hyperfluorescence area on fluorescein angiograms in 11 eyes (36%) was noted. There were no marked differences between classic or occult lesions on FAF imaging. In most cases (29 eyes - 96%) we did not observed any distinct changes in FAF images during follow-up. Only in 4 eyes there were marked differences in distribution and intensity of FAF signal after treatment. Among them changes in 3 eyes corresponded with progression of the disease and in 1 eye with regression of the CNV area. We did not observed any changes in the adjacent area of increased FAF in 11 eyes during follow-up period, even in cases with CNV regression (marked reduction of leakage in fluorescein angiograms and VA improvement).
Obtained data suggest that the retinal pigment epithelium (RPE) may be intact at the CNV area for several months in the presence of choroidal neovascularization, suggesting that VA might be rescued if treatment were effective in suppressing neovascular growth without damaging the RPE-photoreceptors complex. Lack of distinct changes in cases of increased FAF adjacent to CNV areas during follow-up despite of clinical improvement indicates irreversible changes in RPE probably independent of VEGF-related lesions.
Clinical Trial: :
Local Research Ethics Committee - KE-02-54/52/2007
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