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• W2051516247 abstract "Editor, The clinical introduction of intravitreal injections of bevacizumab and ranibizumab for treatment of exudative age-related macular degeneration (AMD) has revolutionized the field of medical therapy for the retina in the last 3 years (Yoganathan et al. 2006; Emerson et al. 2007). Because AMD is a macular disorder, most studies have focused on central visual acuity (VA) as the main outcome parameter. Quality of vision as the final outcome parameter in all clinical ophthalmic science includes, however, other variables, particularly the size of the central scotoma caused by the macular disease (Ergun et al. 2003; Midena et al. 2004; Schmidt-Erfurth et al. 2004). It was therefore the purpose of the present study to assess the size of and change in the central scotoma in a patient with exudative AMD treated with intravitreal bevacizumab. A 71-year-old female patient experienced a progressive loss of vision to 20/50 in her right eye. Ophthalmoscopy and optical coherence tomography (OCT) led to the diagnosis of exudative AMD with an occult subfoveal neovascular membrane characterized by intraretinal macular oedema, subfoveal fluid and elevation of the macula to 232 μm (Fig. 1A). In addition to a conventional assessment of VA, central visual function was examined by direct fundus microperimetry of the perifoveal retina using a microperimeter (Nidek© MP-1; Nidek Co., Ltd, Gamagori, Japan). The size of the central visual field tested was 12 degrees, the spot size was equivalent to a Goldmann III mark, and the power of the light was 10 dB. The patient was given an intravitreal injection of 1.5 mg bevacizumab for which she had signed an informed consent which included the information that the treatment involved an off-label use of the drug. Visual acuity examination and central microperimetry were performed again 2 weeks after the injection. (A) Optical coherence tomography of the macula demonstrating subretinal fluid prior to an intravitreal injection of 1.5 mg bevacizumab for treatment of exudative age-related macular degeneration (AMD). Central retinal thickness: 232 μm; visual acuity (VA): 20/50. (B) Optical coherence tomography of the macula revealing resolution of subretinal fluid and restoration of macular anatomy at 2 weeks after an intravitreal injection of 1.5 mg bevacizumab for treatment of exudative AMD. Central retinal thickness: 203 μm; VA: 20/40. At the follow-up examination, VA was slightly improved from 20/50 to 20/40. Accordingly, OCT showed a reduction in submacular fluid and a decrease in macular thickness from 232 μm to 203 μm (Fig. 1B). The microperimetric examination revealed an improvement in central retinal function, with a decrease in the size of the central relative scotoma and an increase in the differential light threshold as tested by microperimetry (Fig. 2B). (A) Microperimetry results prior to the intravitreal injection of bevacizumab for treatment of exudative age-related macular degeneration (AMD). Green symbols = high differential light threshold; red symbols = low differential light threshold (marked relative scotoma). (B) Microperimetry results at 2 weeks after an intravitreal injection of 1.5 mg bevacizumab for treatment of exudative AMD. Green symbols = high differential light threshold; red symbols = low differential light threshold (marked relative scotoma). Note that the increase in the differential light threshold in the nasal half of the fovea indicates a decrease in the size of the relative pericentral scotoma. The improvement in central VA after the intravitreal injection of agents that block or neutralize vascular endothelial growth factor (VEGF), such as bevacizumab and ranibizumab, as treatment of exudative AMD, and the increase in central VA after the intravitreal application of triamcinolone acetonide as treatment of diffuse diabetic macular oedema have been demonstrated by a growing number of recent studies (Yoganathan et al. 2006; Emerson et al. 2007). Almost all these investigations measured only VA and did not examine the size and shape of the central relative scotoma caused by the macular diseases. The pericentral visual field is, however, of utmost importance to the quality of vision, as patients with advanced retinitis pigmentosa will testify. It was, therefore, the intention of the present pilot study to show that a moderate or even negligible increase in central VA can be accompanied by a marked improvement in the pericentral visual field. Future studies may address how the improvement in the pericentral visual field translates into an increase in reading ability, and how much the subjective change in quality of vision experienced by the patient after therapy depends on the increase in VA and the decrease in the central scotoma, respectively." @default.
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• W2051516247 date "2008-08-26" @default.
• W2051516247 modified "2023-10-16" @default.
• W2051516247 title "Microperimetric changes after intravitreal bevacizumab for exudative age-related macular degeneration" @default.
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• W2051516247 doi "https://doi.org/10.1111/j.1600-0420.2007.01131.x" @default.
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