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Clinical Ophthalmology

Dovepress

open access to scientific and medical research

Open Access Full Text Article

ORIGINAL RESEARCH

Treatment of retinal pigment epithelial detachment with antiangiogenic therapy

Luis Arias

Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain

Purpose: Evaluate the efficacy of pegaptanib, a selective anti-vascular endothelial growth factor (VEGF) agent, and bevacizumab, a nonselective anti-VEGF agent, for retinal pigment epithelial detachment (PED) associated with occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Methods: Prospective, comparative, nonrandomized pilot study included patients with PED comprising 50% of total lesion in subfoveal location with visual acuity (VA) 20/40–20/400 and lesions either previously untreated or treated only with photodynamic therapy/verteporfin. Seven patients received pegaptanib 0.3 mg intravitreally (IVT); eight received IVT bevacizumab 1.25 mg. Follow-up occurred every 4–6 weeks for 6 months. Reinjection of initial medication occurred if there was intra- or subretinal fluid observed by optical coherence tomography (OCT) or increased PED. Endpoints were mean changes from baseline to month 6 in VA (ETDRS) and foveal thickness. Results: At baseline, mean VA was lower, and mean foveal thickness was greater in pegaptanib versus bevacizumab-treated patients (36.1 vs 49.5 letters; 470.4 vs 321.1 µm). Mean improve- ments to month 6 inVA and foveal thickness were greater for pegaptanib (VA: +9.1 vs +7.2 letters; foveal thickness: 88.2 vs 52.9 µm). On average, pegaptanib-treated patients had slower but more sustained improvement in VA and foveal thickness; bevacizumab-treated patients showed rapid improvement with a slow return towards baseline. Both agents were well tolerated. Conclusion: Intravitreal injections of pegaptanib or bevacizumab are both efficacious and safe treatments for PED associated with occult CNV secondary to AMD. Keywords: bevacizumab, pegaptanib, retinal pigment epithelial detachment

Introduction

Correspondence: Luis Arias Department of Ophthalmology, Bellvitge University Hospital, C/Feixa Llarga, S/N, L’Hospitalet de Llobregat, 08907, Barcelona, Spain Tel +34 93 260 76 00 Fax +34 91 490 97 49 Email luisarias@telefonica.net

Retinal pigment epithelial detachment (PED), in which the retinal pigment epithelium (RPE) physically separates from the underlying Bruch’s membrane, occurs in associa- tion with many diseases of the retina, the most common being age-related macular degeneration (AMD).1 In patients with AMD, PEDs are classified by clinical appear- ance and angiographic characteristics as confluent drusen, serous, turbid, hemorrhagic, vascular or fibrovascular, and fibrous or organized.2–5 The underlying pathophysiology of PED is complex and not clearly understood. Several contributing mechanisms have been proposed, the most obvious being displacement of the RPE by exudation from choroidal neovascularization (CNV). Because CNV is not always identified in patients with PED, however, controversy exists as to whether CNV develops as a complication of existing PED6 or whether the growth of CNV vessels through Bruch’s membrane directly causes PED.5 Bird and Marshall7 suggested that PED results when Bruch’s

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Clinical Ophthalmology 2010:4 369–374 © 2010 Arias, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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