Clinical experience in the treatment of neovascular age-related macular degeneration with pegaptanib

BACKGROUND: Intravitreal anti-VEGF therapy with Pegaptanib was effective in neovascular AMD in the VISION study. We report our experience with Macugen for the treatment of occult or minimally classic choroidal neovascularisation (CNV) due to age-related macular degeneration (AMD). PATIENTS AND METHODS: 35 eyes of 35 patients with occult CNV or minimally classic CNV due to neovascular AMD not eligible for PDT were treated with intravitreal injection of 0.3 mg Pegaptanib. An average of 2.74 injections per patient was administered. Before, and every 3 months after treatment, visual acuity, intraocular pressure measurement, angiography and OCT examinations were performed. One month after treatment only visual acuity, intraocular pressure measurement, and OCT examinations were performed. Visual acuity measurements and an eye examination were done on the first and second day after injection, after 4-6 weeks and at months 3 and 6. RESULTS: Intravitreal Pegaptanib was well tolerated and we had no complications. Mean visual acuity was 0.38 +/- 0.23 at baseline, after one month 0.38 +/- 0.26, at 3 months it was 0.39 +/- 0.22 and at 6 months 0.41 +/- 0.26. OCT examinations showed a decrease in central retinal thickness from 277 microm to 254 microm. In 91.4 % of the eyes the visual acuity was stabilised or improved. No patient had an elevated intraocular pressure after 6 months. CONCLUSIONS: Intravitreal therapy with Pegaptanib was safe and effective. The majority of patients showed a stabilisation in all the assessed parameters. In clinical practice unselective VEGF inhibition should be considered carefully for patients with high cardiovascular risk profile or thromboembolic events in the history.