Macular Degeneration: Rosenfeld P

Geitzenauer W, Michels S, Prager F, Kornek G, Vormittag L, Rosenfeld P, Schmidt-Erfurth U. · Klinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Allgemeines Krankenhaus, Wien. · Klin Monatsbl Augenheilkd. · Pubmed #17063425 No free full text.

Abstract: PURPOSE: The purpose of this study was to evaluate the early treatment response following systemic and intravitreal bevacizumab therapy in patients with neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS: In a prospective cohort study 12 eyes with neovascular AMD were treated with 5 mg/kg systemic bevacizumab, and 13 eyes with 1 mg intravitreal bevacizumab. Systemic therapy was given three times at 2-week intervals, intravitreal therapy up to three times at 4-week intervals. Patients were evaluated according to best corrected visual acuity (VA) and optical coherence tomography (OCT) at baseline as well as at week 1, week 4 and week 12 after therapy. Fluorescein angiography (FA) was performed at baseline and week 12. RESULTS: Systemic and intravitreal bevacizumab therapy showed a treatment response within one week. Visual acuity improved at week 1 by 4.9 letters from baseline in the systemic and by 6.9 letters in the intravitreal treatment group. Central retinal thickness (CRT), as measured by OCT decreased by 51.9 microm and 176.4 microm, respectively. At month 3 a persistent treatment effect was detectable. Mean gain in visual acuity was 11 letters in the systemic and 8.3 letters in the intravitreal group, CRT had decreased by 100 microm and 153.8 microm, respectively. Leakage as evaluated by FA was significantly reduced or absent in all patients. CONCLUSION: The early treatment responses following systemic and intravitreal bevacizumab appear to be similar. Both groups show improvement in VA and decrease in CRT within 1 week and up to 3 months. Long-term follow-up is required to evaluate the safety and treatment durability of both treatment modalities using bevacizumab.

Barbazetto I, Burdan A, Bressler NM, Bressler SB, Haynes L, Kapetanios AD, Lukas J, Olsen K, Potter M, Reaves A, Rosenfeld P, Schachat AP, Strong HA, Wenkstern A, Anonymous00097, Anonymous00098. · Medizinische Universität zu Lübeck, Klinik für Augenheilkunde, Lübeck, Germany. · Arch Ophthalmol. · Pubmed #12963608 No free full text.

Abstract: OBJECTIVE: To describe fluorescein angiographic guidelines for the use of verteporfin therapy in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) or other conditions based on 2-year vision outcomes from the Treatment of Age-Related Macular Degeneration With Photodynamic Therapy (TAP) Investigation and Verteporfin in Photodynamic Therapy (VIP) Trial. METHODS: Three multicenter, double-masked, placebo-controlled randomized clinical trials at 28 ophthalmology clinical centers in Europe and North America involving prospectively identified patients with best-corrected visual acuity (Snellen equivalent) of approximately 20/20 to 20/200, subfoveal CNV secondary to AMD or pathologic myopia with evidence of CNV, and a lesion greatest linear dimension of 5400 micro m or less. Fluorescein angiography was to be performed on all patients at enrollment and at regular 3-month follow-up visits through 2 years. The initial treatment laser spot size and all subsequent treatment decisions were based on the investigator's interpretation of these fluorescein angiograms. Photographic materials forwarded to the Wilmer Photograph Reading Center were reviewed by masked graders. MAIN OUTCOME MEASURES: Baseline angiographic features, including lesion composition and size, morphologic response to treatment during follow-up (eg, absence of leakage), and reliability (kappa values) of grading selected characteristics based on a 10% regrading of baseline visits. RESULTS: Terms and examples of different lesions and lesion components are provided to assist recognition of fluorescein angiographic characteristics of choroidal neovascular lesions that were important in determining when and where to apply verteporfin therapy. The kappa statistics for agreement of identification of lesion characteristics by the Wilmer Photograph Reading Center for these trials ranged from 0.70 to 0.85. CONCLUSIONS: Ophthalmologists should consider interpreting fluorescein angiographic images of subfoveal lesions with terms provided to follow recommendations regarding which patients are most likely to benefit from verteporfin therapy based on results from the TAP Investigation and VIP Trial.

Singerman LJ, Brucker AJ, Jampol LM, Lim JI, Rosenfeld P, Schachat AP, Spaide RF. · Retina Associates of Cleveland, Cleveland, OH, USA. · Retina. · Pubmed #16208185 No free full text.

Abstract: Several recent developments may provide an opportunity to improve outcome in individuals who develop neovascular age-related maculopathy (age-related macular degeneration [ARMD]). Concurrent with progress in isolating clinically relevant subtypes of neovascular ARMD, several therapies have been introduced that show promise for halting progression of this disorder. However, data from controlled clinical trials to test the relative efficacy of different management strategies across these subtypes of disease presentation remain limited. In addition, strategies to control ARMD may evolve quickly as more is learned about how specific molecular events, such as cell-mediated inflammation and angiogenesis, contribute to disease expression. A roundtable of investigators was convened to discuss and summarize recent progress in the treatment of ARMD. Case studies were then presented to provide an opportunity for experts to reveal their specific thought processes in the approach to neovascular ARMD based on their own interpretation of current clinical data and empirical experience.