Macular Degeneration: Altaweel M

Cunningham ET, Adamis AP, Altaweel M, Aiello LP, Bressler NM, D'Amico DJ, Goldbaum M, Guyer DR, Katz B, Patel M, Schwartz SD, Anonymous00243. · Stanford University, USA. · Ophthalmology. · Pubmed #16154196 No free full text.

Abstract: OBJECTIVE: To evaluate the safety and efficacy of pegaptanib sodium injection (pegaptanib) in the treatment of diabetic macular edema (DME). DESIGN: Randomized, double-masked, multicenter, dose-ranging, controlled trial. PARTICIPANTS: Individuals with a best-corrected visual acuity (VA) between 20/50 and 20/320 in the study eye and DME involving the center of the macula for whom the investigator judged photocoagulation could be safely withheld for 16 weeks. INTERVENTION: Intravitreous pegaptanib (0.3 mg, 1 mg, 3 mg) or sham injections at study entry, week 6, and week 12 with additional injections and/or focal photocoagulation as needed for another 18 weeks. Final assessments were conducted at week 36. MAIN OUTCOME MEASURES: Best-corrected VA, central retinal thickness at the center point of the central subfield as assessed by optical coherence tomography measurement, and additional therapy with photocoagulation between weeks 12 and 36. RESULTS: One hundred seventy-two patients appeared balanced for baseline demographic and ocular characteristics. Median VA was better at week 36 with 0.3 mg (20/50), as compared with sham (20/63) (P = 0.04). A larger proportion of those receiving 0.3 mg gained VAs of > or =10 letters (approximately 2 lines) (34% vs. 10%, P = 0.003) and > or =15 letters (18% vs. 7%, P = 0.12). Mean central retinal thickness decreased by 68 microm with 0.3 mg, versus an increase of 4 microm with sham (P = 0.02). Larger proportions of those receiving 0.3 mg had an absolute decrease of both > or =100 microm (42% vs. 16%, P = 0.02) and > or =75 microm (49% vs. 19%, P = 0.008). Photocoagulation was deemed necessary in fewer subjects in each pegaptanib arm (0.3 mg vs. sham, 25% vs. 48%; P = 0.04). All pegaptanib doses were well tolerated. Endophthalmitis occurred in 1 of 652 injections (0.15%/injection; i.e., 1/130 [0.8%] pegaptanib subjects) and was not associated with severe visual loss. CONCLUSIONS: In this phase II trial, subjects assigned to pegaptanib had better VA outcomes, were more likely to show reduction in central retinal thickness, and were deemed less likely to need additional therapy with photocoagulation at follow-up.

Muni RH, Altaweel M, Tennant M, Weaver B, Kertes PJ. · Department of Ophthalmology and Vision Sciences, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. · Retina. · Pubmed #18667952 No free full text.

Abstract: OBJECTIVES: To determine inter- and intraobserver agreement among Canadian retina specialists in their angiographic classification of choroidal neovascularization and their decision to treat with photodynamic therapy. Agreement was also determined between retina specialists and a Reading Center. METHODS: Forty retina specialists graded 24 cases of exudative age-related macular degeneration on two occasions separated by 6 months. Participants were asked to categorize the choroidal neovascularization and indicate if they would treat with photodynamic therapy. Agreement was determined for decision to treat and for interpretation of the fluorescein angiogram. Angiographic interpretation by participants was compared with that of the Reading Center. RESULTS: The kappas among the 40 participants for lesion categorization and treatment decision were 0.43 (95% confidence interval: 0.36-0.52) and 0.29 (95% confidence interval: 0.18-0.42), respectively. The kappa for intraobserver agreement was 0.57 (95% confidence interval: 0.50-0.64) for lesion categorization and 0.58 (95% confidence interval: 0.43-0.74) for treatment decision. The mean percent agreement with the Reading Center for lesion categorization was 65.4%. CONCLUSIONS: There was moderate interobserver agreement for choroidal neovascularization categorization and poor agreement among Canadian retina specialists for decision to treat with photodynamic therapy. There was moderate intraobserver agreement for both treatment decision and lesion categorization. There was moderate agreement between observers and the Reading Center for angiographic choroidal neovascularization categorization.

Adamis AP, Altaweel M, Bressler NM, Cunningham ET, Davis MD, Goldbaum M, Gonzales C, Guyer DR, Barrett K, Patel M, Anonymous00106. · No affiliation provided · Ophthalmology. · Pubmed #16343627 No free full text.

Abstract: OBJECTIVE: To study effects of intravitreal pegaptanib (Macugen) on retinal neovascularization. DESIGN: Retrospective analysis of a randomized clinical trial. PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURES: Individuals with retinal neovascularization identified from a multicenter, randomized, controlled trial evaluating pegaptanib for treatment of diabetic macular edema, with a best-corrected visual acuity letter score between 68 and 25 (approximate Snellen equivalent between 20/50 and 20/320) and receiving a sham injection or intravitreal pegaptanib (0.3 mg, 1 mg, 3 mg) administered at study entry, week 6, and week 12, with additional injections and/or focal photocoagulation as needed during the ensuing 18 weeks, up to a maximum of 6 pegaptanib/sham therapies, were evaluated. Scatter panretinal photocoagulation before study enrollment was permitted, but not within 6 months of randomization and study entry. Changes in retinal neovascularization were assessed on fundus photographs and fluorescein angiograms graded at a reading center in a masked fashion. RESULTS: Of 172 participants, 19 had retinal neovascularization in the study eye at baseline. Excluding 1 who had scatter photocoagulation 13 days before randomization and 2 with no follow-up photographs, 1 of the remaining 16 subjects had panretinal photocoagulation during study follow-up. Of these 16 subjects, 8 of 13 (62%) in a pegaptanib treatment group (including the one receiving panretinal photocoagulation), 0 of 3 in the sham group, and 0 of 4 fellow (nonstudy) eyes showed either regression of neovascularization on fundus photographs or regression or absence of fluorescein leakage from neovascularization (or both) at 36 weeks. In 3 of 8 with regression, neovascularization progressed at week 52 after cessation of pegaptanib at week 30. CONCLUSIONS: Most subjects with retinal neovascularization at baseline assigned to pegaptanib showed regression of neovascularization by week 36. These findings suggest a direct effect of pegaptanib upon retinal neovascularization in patients with diabetes mellitus.