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Intravitreal injection of pegaptanib treated macular edema secondary to branch retinal vein occlusion, according to a study.

Intravitreal Macugen (pegaptanib sodium injection, Eyetech/Pfizer), a selective VEGF inhibitor, is approved for treatment of age-related macular degeneration.

It has also been shown to improve visual acuity in patients with central retinal vein occlusion, "suggesting that VEGF contributes to the edema and subsequent visual loss resulting from occlusive retinal vascular diseases," the authors said.

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The prospective, randomized study included 20 patients. Fifteen patients received a 0.3-mg dose of pegaptanib and five patients received a 1-mg dose; doses were given at baseline, 6 weeks, 12 weeks and at 6-week intervals out to 48 weeks.

Optical coherence tomography was used to assess macular edema and macular thickness. Eighteen patients completed the 54-week follow-up.

Results showed that mean best corrected visual acuity improved by 11 letters at 1 week from the baseline of 56 letters. Mean BCVA improved by 12 letters at 30 weeks and 14 letters at 54 weeks. Both doses yielded similar improvements.

Mean center point thickness decreased from 489 µm at baseline to 291 µm at 1 week, 263 µm at 30 weeks and 284 µm at 54 weeks. No cases of endophthalmitis, traumatic cataract or sustained elevated IOP were identified, the data showed.

Limitations of the study included small patient sample and lack of a comparator group, the authors said.

Even though this study of the use of pegaptanib to treat branch retinal vein occlusion-related macular edema was small and uncontrolled, the results were impressive. The treated patients had a mean visual acuity improvement of nearly three lines at the end of 1 year of follow-up and over 50% of patients gained three or more lines of visual acuity. In addition, optical coherence tomography showed rapid and sustained improvement in central retinal thickness in the majority of patients. This study suggests that even selective VEGF inhibition can be effective in treating macular edema from venous occlusion. This sets the stage to consider formally comparing selective (pegaptanib) to nonselective (ranibizumab or bevacizumab) VEGF inhibitors in clinical trials to determine the relative efficacy, safety and duration of action of the three available agents for this indication.

– Carl D. Regillo, MD
Retina Service, Wills Eye Institute, Philadelphia

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