A pilot study of the use of oral 13–cis retinoic acid for treatment of subfoveal occult AMD CNV

Abstract

Abstract: : Purpose:Determine whether evidence for efficacy exists for oral 13–cis retinoic acid (RA) to stabilize visual acuity in AMD patients with subfoveal occult CNV. Methods: We performed a prospective pilot trial using oral 13–cis RA as a treatment for subfoveal occult CNV in AMD patients. After obtaining informed consent, patients underwent laboratory tests for CBC, LFTs, cholesterol and triglyceride. Patients were instructed to take 40 mg. of 13–cis RA (tablet) twice daily for five months, stop treatment for two months and then resume treatment for five additional months. Patients were followed monthly with ETDRS visual acuity (VA), anterior and posterior segment examinations, fluorescein angiography, fundus photography and laboratory tests. OCT was performed at six and twelve months. Results: Eleven patients, ranging in age from 64 to 88 years (median 73 years) were enrolled. VA ranged from 20/40 to 20/400. Baseline fluorescein angiography showed subfoveal predominantly occult CNV in all patients. Follow–up ranged from five to 16 months (median12 months). Initial visual acuity (VA) ranged from 20/ 40 to 20/ 400 (median 20/ 64). Median VAs were 20/ 80 at three, 20/100 at six and 20/ 160 at 12 months. VA was within + / – 2 lines of initial VA in 82 % at three, 50 % at six, 33 % at nine and 67 % of patients at 12 months. VA was three or more lines worse than initial VA in 9 % at three months, 38 % at six, 33 % at nine and 33 % at 12 months. VA was improved two or more lines in 45 % at three, 25 % at six, 50 % at nine and 33 % at 12 months. Conclusions:Oral 13–cis RA may play a role in stabilizing or improving visual acuity in patients with occult subfoveal CNV in AMD patients.

Keywords: age–related macular degeneration • choroid: neovascularization • clinical (human) or epidemiologic studies: outcomes/complications