LONG-TERM OUTCOMES AND INCIDENCE OF RECURRENCE OF NEOVASCULARIZATION IN TREATED EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To assess the long-term visual outcome and incidence of recurrence of neovascular age-related macular degeneration (NAMD) treated with intravitreal anti-VEGF injections (IVAI). METHODS: One hundred and thirty-two consecutive eyes treated with IVAI for NAMD based on an as-needed regimen with a follow-up ≥5 years (mean 7.55, range 5-9.67) were retrospectively reviewed. Main outcome measures included visual acuity, yearly number of IVAI, and occurrence of a long-term remission, defined as no recurrence of NAMD for ≥12 consecutive months. RESULTS: Mean baseline visual acuity was 20/100. Mean final visual acuity change was -3.41 letters. Mean overall IVAI number was 22.8 ± 17.4 (range 2-71), decreasing from 4.6 during Year 1 to 2.21 during Year 8. A significant positive correlation was found between the number of IVAI during the first year of treatment and the overall number of IVAI during 5 years, 6 years, 7 years, or 8 years follow-up (r = 0.67-0.70, P <0.0001). Long-term remission occurred at least once in 83/132 eyes (63%) and was associated with a better visual outcome (-1.04 vs. -7.43 letters, P = 0.034). Incidence of yearly remission of NAMD increased from 28% during Year 2 to 59% during Year 8, fitting along a single straight line (+5.231%/year, R = 0.9511). CONCLUSION: The incidence of recurrence of treated NAMD decreases slowly but steadily during follow-up. The number of years of follow-up is the main factor to assess the proportion of treated eyes at remission at a given moment. Incidence of recurrence of neovascularization during year 1 and length of follow-up are significant factors when tailoring an optimal long-term follow-up regimen.

Photodynamic therapy vs limited macular translocation in the management of subfoveal choroidal neovascularization in pathologic myopia: a two-year study.

PURPOSE: To compare the results of limited macular translocation and photodynamic therapy (PDT) in subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia with a 24-month follow-up. DESIGN: Retrospective analysis of nonrandomized interventional clinical study. METHODS: Retrospective review of 66 consecutive patients: 34 myopic eyes with subfoveal neovascularization treated by PDT and 32 operated on with the translocation technique. Translocation was considered principally when the lesion size was adequate (nasal inferior margin of the membrane less than half a disk diameter away from the center of the fovea) with duration of symptoms of less than four months. Main outcome measure was the postoperative change in visual acuity. RESULTS: In the translocation group, mean gain in visual acuity was greater than in the PDT group (+2.8 lines and -1.8 line, respectively, P = .001). In the translocation group, 55% of eyes gained 3 lines or more at two years compared with 10% in the PDT group. Sixty percent of eyes in the translocation group vs 40% in the PDT group had an improvement of at least five letters. Mean foveal displacement after translocation was 906 mum; postoperative complications included retinal detachment (three eyes), macular fold (one eye), and transient diplopia (four eyes). In young patients, the postoperative gain was better in both groups. In the translocation group, mean survival time for choroidal neovascularization recurrence was 40 months for patients younger than 40 years and 20 months for older patients. CONCLUSIONS: Translocation showed better results than PDT at two years. Further studies are required to confirm these findings.

[Age-related macular degeneration]. / Dégénérescence maculaire liée à l'âge.

UNLABELLED: EPIDEMIOLOGICAL AND PATHOGENIC DATA: Age-related macular degeneration (ARMD) is the first cause of blindness in industrialized countries in patients over the age of 55. Its prevalence increases with age, affecting up to 25% of the population aged over 75. The pathogenesis of this disease is not well known. Not only aging, but also other varying degrees of genetic and environmental factors are implied. CLINICAL ASPECTS: Precursors (first clinical signs of ARMD) can be observed on examination of the fundus: drusen (localized deposits of lipids and lipoproteins) and alterations in retinal pigment epithelium (RPE) (hypo- or hyperpigmentation). Two forms of complications are observed: atrophic (or "dry") and exudative (or "wet"). The atrophic form is defined by the presence of degeneration in the central RPE, choriocapillaris and photoreceptors, resulting from the enlargement and/or coalescence of small areas of peri-foveolar atrophy (or "geographic" atrophy). The exudative form, responsible for the majority of cases of blindness due to ARMD, is characterized by the appearance of choroidal new vessels, identifiable on fluorescein angiography and responsible for serous retinal detachment, edema and hemorrhage, leading to the destruction of the macular photoreceptors. FROM A THERAPEUTIC POINT OF VIEW: Treatment of the atrophic form is currently only palliative (visual aids and re-habilitation of low vision). Treatments of the exudative form having demonstrated their efficacy are laser photocoagulation and dynamic phototherapy with verteporfine, providing relative stabilization of visual acuity in around 2/3 of the eyes. Other treatments are under evaluation: anti-angiogenic treatments, surgical techniques (ablation of the new vessels, foveal translocation), new laser treatments (transpupillary thermotherapy, selective photocoagulation of the feeder vessels). Photoreceptor and pigment epithelium transplantations or implantation of microphotodiodes represent other long-term alternatives.