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Dunavoelgyi, R; Sacu, S; Eibenberger, K; Palkovits, S; Leydolt, C; Pruente, C; Schmidt-Erfurth, U.
Retreatment with anti-vascular endothelial growth factor therapy based on changes in visual acuity after initial stabilization of neovascular age-related macular degeneration: 3-year follow-up results.
Retina. 2012; 32(8): 1471-1479. Doi: 10.1097/IAE.0b013e318236e805
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Palkovits Stefan

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Purpose: To evaluate the 3-year therapeutic benefit of intravitreal bevacizumab in neovascular related macular degeneration (nAMD) in a standard clinical setting involving 3 initial injections and a pro re nata regimen as recommended in the PRONTO study. Methods: In this interventional clinical study, 181 eyes of 160 consecutive patients with active neovascular related macular degeneration meeting recommended criteria for inclusion and protocol criteria for anti-vascular endothelial growth factor therapy undergoing intravitreal bevacizumab monotherapy were observed. Data of treatment-naive eyes (Group 1, n = 114) were analyzed separately from eyes that had undergone previous photodynamic therapy plus intravitreal triamcinolone (Group 2, n = 67). Re-treatment criteria were based on clinical outcome following the official European label regimen. After 1 year of continuous service at an academic referral center, follow-up was performed in private practices in collaboration with the referral center. Main outcome parameters were best-corrected visual acuity and central retinal thickness. Results: After 3 years, best-corrected visual acuity decreased in the overall population (0.23 +/- 0.16 to 0.16 +/- 0.21. P = 0.002) and in both groups compared with baseline (0.24 +/- 0.21 to 0.17 +/- 0.21, Group 1, P = 0.03; 0.22 +/- 0.19 to 0.16 +/- 0.21, Group 2, P > 0.05), whereas central retinal thickness increased in the overall population (291 +/- 92 to 319 +/- 110 mu m, P = 0.01) and in both groups (291 +/- 96 to 325 +/- 117 mu m, Group 1, P > 0.05; 290 +/- 83 to 308 +/- 96 mu m, Group 2, P > 0.05) because of chronic cystic degeneration changes of the macula. Mean treatment rate was 5.1 +/- 3.9 (Group 1) versus 3.7 +/- 2.7 (Group 2, P = 0.01). Five cases of severe intraocular inflammation after intravitreal bevacizumab were documented. Discussion: While the functional and morphological benefits persisted for the first year after intravitreal bevacizumab treatment, after this time both functional and morphologic results were disappointing during long-term follow-up with visual acuity loss as the main retreatment criterion. After stabilization of the disease, a monthly follow-up of optical coherence tomography and re-treatment based on morphologic, clinical, and vision outcomes may increase the efficacy in patients with neovascular related macular degeneration under anti-vascular endothelial growth factor treatment. RETINA 32:1471-1479, 2012
Find related publications in this database (using NLM MeSH Indexing)
Aged -
Angiogenesis Inhibitors - administration & dosage Angiogenesis Inhibitors - adverse effects
Antibodies, Monoclonal, Humanized - administration & dosage Antibodies, Monoclonal, Humanized - adverse effects
Female -
Fluorescein Angiography -
Follow-Up Studies -
Humans -
Intravitreal Injections -
Male -
Prospective Studies -
Retina - pathology
Retreatment -
Tomography, Optical Coherence -
Treatment Outcome -
Vascular Endothelial Growth Factor A - antagonists & inhibitors
Visual Acuity - physiology
Wet Macular Degeneration - drug therapy Wet Macular Degeneration - physiopathology

Find related publications in this database (Keywords)
age-related macular degeneration
choroidal neovascularization
intravitreal bevacizumab
long-term maintenance
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