Macular Degeneration: Cooney MJ

Goldstein M, Loewenstein A, Barak A, Pollack A, Bukelman A, Katz H, Springer A, Schachat AP, Bressler NM, Bressler SB, Cooney MJ, Alster Y, Rafaeli O, Malach R, Anonymous00107. · Department of Ophthalmology, Tel-Aviv Medical Center, Israel. · Retina. · Pubmed #15805906 No free full text.

Abstract: PURPOSE: To compare the preferential hyperacuity perimeter (PHP) with an Amsler grid in detection of age-related macular degeneration (AMD). METHODS: Patients underwent refraction, visual acuity examination, PHP, Amsler grid examination, and macular photography. RESULTS: One hundred fifty patients participated in the trial. Of 19 eyes with neovascular AMD, 19 (100%) were positive on the PHP, and 10 (53%), on the Amsler grid. Of 27 eyes with geographic atrophy, 26 (96%) were positive on the PHP, and 12 (44%), on the Amsler grid. Of 20 eyes with intermediate AMD, 14 (70%) were positive on the PHP, and 4 (20%), on the Amsler grid. Of 51 eyes with early AMD, 21 (41%) were positive on the PHP, and 4 (8%), on the Amsler grid. Of 33 eyes with no AMD, 6 (18%) were positive on the PHP, and none, on the Amsler grid. Thus, 80 (68%) of 117 patients with AMD had a positive PHP, while 30 (26%) had positive results of Amsler grid examination (P < 0.001, McNemar test). CONCLUSION: The PHP had greater sensitivity, although with a relatively high rate of false-positive results for healthy individuals, than the Amsler grid in detecting AMD-related lesions.

Ahmad S, Bearelly S, Stinnett SS, Cooney MJ, Fekrat S. · Department of Ophthalmology, Duke University Medical Center, Erwin Road, Durham, NC 27710, USA. · Am J Ophthalmol. · Pubmed #18400198 No free full text.

Abstract: PURPOSE: To evaluate the response of eyes treated with photodynamic therapy (PDT) for predominantly hemorrhagic lesions in neovascular age-related macular degeneration (NVAMD). DESIGN: Consecutive, interventional case series. METHODS: A retrospective review was conducted of eyes with NVAMD that were treated with PDT for predominantly hemorrhagic subfoveal lesions. Baseline data recorded were patient age, use of aspirin or warfarin, history of previous PDT treatment, visual acuity (VA), extent of subretinal hemorrhage (SRH), and central foveal thickness (CFT) and total macular volume (TMV) measured by optical coherence tomography (OCT). Follow-up VA, SRH status, and complications were recorded. RESULTS: Twenty-one eyes of 21 patients were identified with a mean posttreatment follow-up of 9.4 months. Mean pretreatment VA was 20/210, and mean SRH size was 16 disk areas. The SRH resolved in 18 eyes (86%) after a mean of six months, with a mean VA of 20/210. Mean VA for all eyes at most recent follow-up was 20/250. Thirteen (62%) of 21 eyes exhibited stable or improved VA at the most recent follow-up. VA one year after PDT inversely correlated with patient age (P = .045) and initial SRH size (P = .04) and positively correlated with pretreatment VA (P = .01). Previous PDT treatment, use of aspirin or warfarin, and OCT data did not significantly correlate with VA or SRH resolution. CONCLUSIONS: PDT may be an effective treatment for minimizing visual loss in eyes with NVAMD and predominantly hemorrhagic lesions. Further study is warranted to detail the risk-benefit ratio and compare PDT with other treatment modalities.

Bhatnagar P, Spaide RF, Takahashi BS, Peragallo JH, Freund KB, Klancnik JM, Cooney MJ, Slakter JS, Sorenson JA, Yannuzzi LA. · Vitreous-Retina-Macula Consultants of New York, New York, USA. · Retina. · Pubmed #17891007 No free full text.

Abstract: PURPOSE: To evaluate the short-term outcomes after intravitreal ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA) injection in patients with neovascular age-related macular degeneration. METHODS: A review of data for consecutive patients who received intravitreal ranibizumab injection was conducted. The main outcome measures were mean visual acuity and central macular thickness at 3 months compared with those at baseline. Response to ranibizumab therapy was evaluated with particular attention to prior treatment with bevacizumab (Avastin; Genentech, Inc.). RESULTS: Mean baseline visual acuity of 231 eyes of 231 patients was 20/152, and 189 patients (81.8%) had undergone prior treatment, with 153 (65.4%) having received intravitreal bevacizumab. Mean visual acuity at 3 months, available for 203 patients (88%), was 20/126 (P = 0.004). Mean visual acuity for 98 patients treated with bevacizumab within 3 months before ranibizumab injection was 20/100 at baseline and 20/98 at 3 months (P = 0.35). Mean baseline central macular thickness was 278 microm for all patients and improved to 211 microm at 3 months (P < 0.001). Macular thickness decrease was noted irrespective of previous bevacizumab therapy. CONCLUSION: Ranibizumab therapy was associated with significant improvements in mean visual acuity and central macular thickness for the group of all patients. Patients who had received bevacizumab treatment within 3 months before initiating ranibizumab treatment had stability of, but no improvement in, visual acuity.

Bearelly S, Cooney MJ, Stinnett S, Fekrat S. · Albert Eye Research Institute, Duke University Eye Center, Department of Ophthalmology, Durham, NC 27710, USA. · Ann Ophthalmol (Skokie). · Pubmed #17726219 No free full text.

Abstract: We retrospectively evaluated the effectiveness of intravitreal triamcinolone in treating 19 eyes with macular edema related to branch retinal vein occlusion (BRVO). Eyes with nonischemic BRVO respond more favorably than those with ischemic BRVO. A single injection of intravitreal triamcinolone led to elevated intraocular pressure in 3 of 19 eyes (16%). Half of phakic eyes had progression of cataract. Retreatment may be necessary.

Matsumoto Y, Freund KB, Peiretti E, Cooney MJ, Ferrara DC, Yannuzzi LA. · Vitreous-Retina-Macula Consultants of New York, and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York 10022, USA. · Retina. · Pubmed #17420693 No free full text.

Abstract: BACKGROUND: Bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor (VEGF), has been given via intravitreal injection as an off-label therapy for both neovascular age-related macular degeneration and for macular edema secondary to retinal vascular disease. The authors describe three patients with macular edema secondary to retinal venous occlusion whose edema initially responded to intravitreal bevacizumab but subsequently recurred in excess of that observed before treatment. METHODS: This is a retrospective case series of three patients with macular edema secondary to retinal vein occlusion treated with intravitreal bevacizumab. RESULTS: In all three patients, the rebound retinal edema observed was more pronounced than that present before treatment. CONCLUSION: These cases suggest a potential limitation of using relatively short-acting VEGF antagonists in retinal vascular disease of a chronic nature. Frequent repeated injections may be required to prevent a rebound effect with no clearly defined endpoint. Until the long-term safety of multiple injections of these agents is established, the authors recommend caution in using this treatment strategy.

Fackler TK, Reddy S, Bearelly S, Stinnett S, Fekrat S, Cooney MJ. · Duke Eye Center, Albert Eye Research Institute, North Carolina, USA. · Ann Acad Med Singapore. · Pubmed #17102894 links to  free full text

Abstract: AIM: To review the outcomes of eyes with neovascular age-related macular degeneration (AMD) treated with photodynamic therapy (PDT) with verteporfin and intravitreal triamcinolone acetonide injection. MATERIALS AND METHODS: We retrospectively reviewed the outcomes of consecutive eyes with neovascular AMD that received an intravitreal triamcinolone injection within 1 week of their first PDT and had at least 6 months of follow-up. Eyes were retreated with PDT at 3-month intervals if angiographic leakage was present. RESULTS: Twenty-six eyes from 24 patients were identified. The mean visual acuity at baseline was 20/118 (median 20/112). The mean visual acuity decreased to 20/138 at 9 months (P = 0.24, n = 15) and to 20/174 at 12 months (P = 0.23, n = 8). The change in visual acuity from baseline was not statistically significant at any time point. The mean central foveal thickness by OCT measured 342 microm at baseline and decreased to 296 microm at 12 months (P = 0.31). Sixty-two per cent of eyes required no additional PDT at 12 months. Nineteen per cent of 26 eyes had a rise in intraocular pressure that was controlled with topical medication alone. CONCLUSION: Photodynamic therapy with verteporfin combined with intravitreal triamcinolone injection in the treatment of neovascular AMD may be superior to PDT alone by decreasing visual loss and reducing the number or retreatments.

Spaide RF, Laud K, Fine HF, Klancnik JM, Meyerle CB, Yannuzzi LA, Sorenson J, Slakter J, Fisher YL, Cooney MJ. · Vitreous Retina Macula Consultants of New York and the LuEsther T. Mertz Retinal Research Center at Manhattan Eye, Ear & Throat Hospital, 460 Park Avenue, New York, NY 10022, USA. · Retina. · Pubmed #16603955 No free full text.

Abstract: PURPOSE: To describe the short-term anatomical and visual acuity responses after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS: We conducted a retrospective study of patients with CNV secondary to AMD who were treated with intravitreal injection of bevacizumab (1.25 mg) during a 3-month period. Patients underwent best-corrected Snellen visual acuity testing, optical coherence tomography, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: There were 266 consecutive eyes of 266 patients who received injections, and follow-up information was available for 251 (94.4%). The mean age of the patients was 80.3 years, the mean baseline visual acuity was 20/184, and 175 (69.7%) had inadequate response to alternate methods of treatment. At the 1-month follow-up (data available for 244 patients), the mean visual acuity was 20/137 (P < 0.001 as compared with baseline), and 74 (30.3%) of patients had improvement in visual acuity as defined by a halving of the visual angle. At the 2-month follow-up (data available for 222 patients), the mean visual acuity was 20/122 (P < 0.001), and 78 (31.1%) of patients had visual improvement. At the 3-month follow-up (data available for 141 patients), the mean visual acuity was 20/109 (P < 0.001), and 54 (38.3%) of patients had visual acuity improvement. The mean central macular thickness at baseline was 340 mum and decreased to a mean of 247 microm at month 1 (P < 0.001) and 213 microm at month 3 (P < 0.001). At 1 month, two patients had mild vitritis, as did one patient at 2 months, who had a history of recurrent uveitis. No endophthalmitis, increased intraocular pressure, retinal tear, or retinal detachment occurred. The risk for thromboembolic disorders did not seem to be different than reported previously in studies concerning macular degeneration. CONCLUSION: There were no apparent short-term safety concerns for intravitreal bevacizumab injection for CNV. Treated eyes had a significant decrease in macular thickness and improvement in visual acuity. The follow-up was too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.