NVAMDNeovascular Age-Related Macular Degeneration (ophthalmology)
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There were 14 right eyes and 16 left eyes; 6 of the 30 eyes were pseudophakic and the rest were phakic; 3 eyes were on topical prostaglandin analogues for either glaucoma or ocular hypertension; 1 eye had received PDT for NvAMD seven years previously.
The NvAMD lesion subtype in these 30 eyes was categorised as follows: wholly classic choroidal neovascularisation (CNV) in 7 (23%), occult fibrovascular pigment epithelial detachment (FvPED) in 11 (37%), minimally classic CNV in 5 (17%), predominantly classic CNV in 2 (7%), and retinal angiomatous proliferation (RAP) in 5 (17%).
These changes did not show any relationship to either the NvAMD lesion subtype or visual acuity level.
With regard to non-index eyes, 15 had dryAMD, 9 had inactive NvAMD (macular fibrosis), and 6 eyes had a normal macula.
Given that all systemic factors were matched, we found that the presence of active NvAMD was associated with peripheral FA changes (100% versus 33%, P = 0.009, Fishers test) (Table 3).
Although the number of eyes with NvAMD in this series was small, they report that all eyes with end-stage AMD had abnormal retinal periphery findings on colour and autofluorescence images.
Of the 208 patients studied, 133 (63.9%) had nvAMD in only one eye and 75 (36.1%) in both.
Of note, 67.8% of cases underwent all the three techniques to establish the diagnosis of nvAMD.
During the second year of follow-up about half of the patients (51.4%) received antiangiogenic treatment (50%, n = 104 with ranibizumab; 3.8%, n = 8 with bevacizumab) for nvAMD.
This observational retrospective study, performed in several public health centers in Spain, identified that the management of patients with nvAMD treated with VEGF inhibitors in routine clinical practice was variable and far away from that recommended by the European specialist guidelines in terms of treatment-related and not treatment-related visits.
The delay in the nvAMD diagnosis is likely to be caused by a lack of knowledge about the disease, but the treatment delay could be due to the different regional health systems and the accessibility to them.
As it has been reported in the CATT study [19], a PRN treatment approach for nvAMD patients could offer similar results to fixed monthly injections during the first year of treatment.