Abstract
Purpose::
To examine the efficacy of Pegaptanib in the treatment of eyes with significant hemorrhage and choroidal neovascularization from exudative age-related macular degeneration (AMD).
Methods::
Retrospective review of a consecutive series of 29 eyes of 29 patients who received monotherapy with intravitreal injections of Pegaptanib to treat exudative AMD. All eyes had significant hemorrhage (>50% of the choroidal neovascular complex) in the macula on initial presentation. All patients had at least three injections (average=4) and at least 18 weeks of follow up (average=24). All eyes had baseline and subsequent angiographic imaging performed allowing for photographic documentation of the change in the amount of blood present at 12 weeks and/or the final examination of the study. The amount of blood resolution and level of visual acuity at the end of week 12 (entire cohort) and at the last visit (subsets of the cohort) were recorded.
Results::
The study cohort presented with blood that on average comprised 67.4% of the total lesion size (range 50-100%). After three injections, the blood on average comprised 24.6% of the total lesion size (range 0-90%). A subset of patients received one (n=5) or two (n=15) additional injections. The cohort that continued therapy demonstrated additional blood resorption, with blood comprising 14.2% and 6% of the lesion respectively after four and five injections. Visual acuity also improved overall, with average logMAR visual acuity of 1.08 at initiation improving to 0.99 after two injections. In the subset receiving additional injections, the logMAR acuity improved to 1.03 and 0.97 at injection four and five respectively. After two injections, 89.7% of eyes were responders (loss of less than three lines of vision), 55% of eyes gained at least one line and 20.7% gained three or more lines of vision.
Conclusions::
Eyes with lesions comprised of greater than 50% blood are typically not included in clinical trials for AMD, as prognosis in these eyes has traditionally been considered worse than in eyes without significant hemorrhage. In this cohort, eyes responded well in terms of resorption of blood and improvement in visual acuity. Aggressive treatment of these eyes may be warranted with anti-VEGF agents, as the prognosis seems better than might be expected.
Keywords: age-related macular degeneration • neovascularization • visual acuity