Pegaptanib for Large and Small Lesions in Exudative Age-Related Macular Degeneration

Abstract

Purpose:: To evaluate intravitreal pegaptanib in the treatment of choroidal neovascular membranes associated with exudative age-related macular degeneration (AMD).

Methods:: This is a retrospective case study involving four clinical sites. Included were patients with exudative AMD treated with pegaptanib from 2/05 to 10/06. All patients were naïve to any treatment for AMD. Additional inclusion criteria included Va ≥ 20/400 at the time of first injection, and a minimum of 3 injections. The small lesion subgroup included patients with lesions ≤ 4 disc areas (DA). All patients had fluorescein angiography and visual acuities(Va) documented prior to treatment, and visual acuity measurements on subsequent follow-up visits. The primary outcome was change in visual acuity, as measured by standard office-based Snellen acuity charts. All adverse events occurring during the study period were also recorded.

Results:: When all lesions were considered, 111 eyes of 111 patients were included. The average Va at first treatment was 20/100. The average lesion size was 3.3 disc areas, with 92% being occult. The average line change in Snellen acuity was -2.9 at last follow-up. 41% of patients lost > 3 lines. 14% gained more than 3 lines and 10% maintained greater or equal to 20/40 vision. 43% of patients were switched to an alternate VEGF inhibitor. Average follow-up was 31 weeks, with an average of 4.8 injections. Sixty-six eyes of 66 patients had small lesions (≤4 DA) with an average Va at first treatment of 20/94. The average lesion size was 1.8 disc areas, with 92% being occult lesions. The average change in vision was a loss of 2.0 lines. 62% of patients maintained or improved their pretreatment vision. 15% and 11% gained more than 3 lines and had greater or equal to 20/40 vision, resepectively. Average follow-up was 29 weeks, with an average of 4.7 injections. There were 5 adverse events recorded during the study: 4 intraocular (subretinal hemorrhage, vitreous hemorrhage, and RPE rip) and 1 systemic (TIA followed by an MI after being switched to bevacizumab).

Conclusions:: Pegaptanib provided a treatment alternative that maintained or improved vision in the majority of patients, with 14-15% gaining > 3 lines of vision. With the advent of multiple VEGF inhibitors, it will be important for future studies to help individualize treatment regimens for patients with exudative AMD.

Keywords: age-related macular degeneration • retina