Evolving European guidance on the medical management of neovascular age related macular degeneration

U. Chakravdrthy, Gisèle Soubrane, F. Bandello, V. Chong, C. Creuzot-Garcher, S. A. Dimitrakos, J. F. Korobelnik, M. Larsen, J. Monés, D. Pauleikhoff, C. J. Pournaras, G. Staurenghi, G. Virgili, S. Wolf

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)-thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. Methods: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. Results: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size ≤4 Macular Photocoagulation Study (MPS) disc areas (DA). The new classes of anti-angiogenic agents-namely, pegaptanib sodium and ranibizumab (the latter when peer reviewed phase III data become available) are recommended for subfoveal lesions with any proportion of classic CNV or occult with no classic CNV. For juxtafoveal classic CNV, PDT-V or anti-angiogenic therapy should be considered if the new vessels are so close to the fovea that laser photocoagulation would almost certainly extend under the centre of the foveal avascular zone. For all other well demarcated juxtafoveal lesions and for extrafoveal classic lesions, laser photocoagulation remains the standard treatment. Therapy should be undertaken within 1 week of the fluorescein angiogram on which the clinical decision to treat is based. At each follow up, fluorescein angiography should be performed and best corrected visual acuity measured as a minimum requirement. Conclusions: These recommendations provide evidence based guidance for the choice and use of non-surgical therapies for the management of neovascular AMD. Revisions of the recommendations may be required as new data become available.

Original languageEnglish
Pages (from-to)1188-1196
Number of pages9
JournalBritish Journal of Ophthalmology
Volume90
Issue number9
DOIs
Publication statusPublished - Sep 2006

Fingerprint

Macular Degeneration
Choroidal Neovascularization
Light Coagulation
Photochemotherapy
Lasers
Therapeutics
Retina
Triamcinolone Acetonide
Phase III Clinical Trials
Induced Hyperthermia
Fluorescein Angiography
Laser Therapy
Fluorescein
Visual Acuity
Disease Progression
Consensus
Angiography
Hot Temperature
Pharmacology
verteporfin

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Chakravdrthy, U., Soubrane, G., Bandello, F., Chong, V., Creuzot-Garcher, C., Dimitrakos, S. A., ... Wolf, S. (2006). Evolving European guidance on the medical management of neovascular age related macular degeneration. British Journal of Ophthalmology, 90(9), 1188-1196. https://doi.org/10.1136/bjo.2005.082255

Evolving European guidance on the medical management of neovascular age related macular degeneration. / Chakravdrthy, U.; Soubrane, Gisèle; Bandello, F.; Chong, V.; Creuzot-Garcher, C.; Dimitrakos, S. A.; Korobelnik, J. F.; Larsen, M.; Monés, J.; Pauleikhoff, D.; Pournaras, C. J.; Staurenghi, G.; Virgili, G.; Wolf, S.

In: British Journal of Ophthalmology, Vol. 90, No. 9, 09.2006, p. 1188-1196.

Research output: Contribution to journalArticle

Chakravdrthy, U, Soubrane, G, Bandello, F, Chong, V, Creuzot-Garcher, C, Dimitrakos, SA, Korobelnik, JF, Larsen, M, Monés, J, Pauleikhoff, D, Pournaras, CJ, Staurenghi, G, Virgili, G & Wolf, S 2006, 'Evolving European guidance on the medical management of neovascular age related macular degeneration', British Journal of Ophthalmology, vol. 90, no. 9, pp. 1188-1196. https://doi.org/10.1136/bjo.2005.082255
Chakravdrthy, U. ; Soubrane, Gisèle ; Bandello, F. ; Chong, V. ; Creuzot-Garcher, C. ; Dimitrakos, S. A. ; Korobelnik, J. F. ; Larsen, M. ; Monés, J. ; Pauleikhoff, D. ; Pournaras, C. J. ; Staurenghi, G. ; Virgili, G. ; Wolf, S. / Evolving European guidance on the medical management of neovascular age related macular degeneration. In: British Journal of Ophthalmology. 2006 ; Vol. 90, No. 9. pp. 1188-1196.
@article{96ec6d9a54184affba5881ded60b6bda,
title = "Evolving European guidance on the medical management of neovascular age related macular degeneration",
abstract = "Background: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)-thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. Methods: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. Results: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size ≤4 Macular Photocoagulation Study (MPS) disc areas (DA). The new classes of anti-angiogenic agents-namely, pegaptanib sodium and ranibizumab (the latter when peer reviewed phase III data become available) are recommended for subfoveal lesions with any proportion of classic CNV or occult with no classic CNV. For juxtafoveal classic CNV, PDT-V or anti-angiogenic therapy should be considered if the new vessels are so close to the fovea that laser photocoagulation would almost certainly extend under the centre of the foveal avascular zone. For all other well demarcated juxtafoveal lesions and for extrafoveal classic lesions, laser photocoagulation remains the standard treatment. Therapy should be undertaken within 1 week of the fluorescein angiogram on which the clinical decision to treat is based. At each follow up, fluorescein angiography should be performed and best corrected visual acuity measured as a minimum requirement. Conclusions: These recommendations provide evidence based guidance for the choice and use of non-surgical therapies for the management of neovascular AMD. Revisions of the recommendations may be required as new data become available.",
author = "U. Chakravdrthy and Gis{\`e}le Soubrane and F. Bandello and V. Chong and C. Creuzot-Garcher and Dimitrakos, {S. A.} and Korobelnik, {J. F.} and M. Larsen and J. Mon{\'e}s and D. Pauleikhoff and Pournaras, {C. J.} and G. Staurenghi and G. Virgili and S. Wolf",
year = "2006",
month = "9",
doi = "10.1136/bjo.2005.082255",
language = "English",
volume = "90",
pages = "1188--1196",
journal = "British Journal of Ophthalmology",
issn = "0007-1161",
publisher = "BMJ Publishing Group",
number = "9",

}

TY - JOUR

T1 - Evolving European guidance on the medical management of neovascular age related macular degeneration

AU - Chakravdrthy, U.

AU - Soubrane, Gisèle

AU - Bandello, F.

AU - Chong, V.

AU - Creuzot-Garcher, C.

AU - Dimitrakos, S. A.

AU - Korobelnik, J. F.

AU - Larsen, M.

AU - Monés, J.

AU - Pauleikhoff, D.

AU - Pournaras, C. J.

AU - Staurenghi, G.

AU - Virgili, G.

AU - Wolf, S.

PY - 2006/9

Y1 - 2006/9

N2 - Background: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)-thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. Methods: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. Results: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size ≤4 Macular Photocoagulation Study (MPS) disc areas (DA). The new classes of anti-angiogenic agents-namely, pegaptanib sodium and ranibizumab (the latter when peer reviewed phase III data become available) are recommended for subfoveal lesions with any proportion of classic CNV or occult with no classic CNV. For juxtafoveal classic CNV, PDT-V or anti-angiogenic therapy should be considered if the new vessels are so close to the fovea that laser photocoagulation would almost certainly extend under the centre of the foveal avascular zone. For all other well demarcated juxtafoveal lesions and for extrafoveal classic lesions, laser photocoagulation remains the standard treatment. Therapy should be undertaken within 1 week of the fluorescein angiogram on which the clinical decision to treat is based. At each follow up, fluorescein angiography should be performed and best corrected visual acuity measured as a minimum requirement. Conclusions: These recommendations provide evidence based guidance for the choice and use of non-surgical therapies for the management of neovascular AMD. Revisions of the recommendations may be required as new data become available.

AB - Background: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)-thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. Methods: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. Results: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size ≤4 Macular Photocoagulation Study (MPS) disc areas (DA). The new classes of anti-angiogenic agents-namely, pegaptanib sodium and ranibizumab (the latter when peer reviewed phase III data become available) are recommended for subfoveal lesions with any proportion of classic CNV or occult with no classic CNV. For juxtafoveal classic CNV, PDT-V or anti-angiogenic therapy should be considered if the new vessels are so close to the fovea that laser photocoagulation would almost certainly extend under the centre of the foveal avascular zone. For all other well demarcated juxtafoveal lesions and for extrafoveal classic lesions, laser photocoagulation remains the standard treatment. Therapy should be undertaken within 1 week of the fluorescein angiogram on which the clinical decision to treat is based. At each follow up, fluorescein angiography should be performed and best corrected visual acuity measured as a minimum requirement. Conclusions: These recommendations provide evidence based guidance for the choice and use of non-surgical therapies for the management of neovascular AMD. Revisions of the recommendations may be required as new data become available.

UR - http://www.scopus.com/inward/record.url?scp=33748474191&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748474191&partnerID=8YFLogxK

U2 - 10.1136/bjo.2005.082255

DO - 10.1136/bjo.2005.082255

M3 - Article

VL - 90

SP - 1188

EP - 1196

JO - British Journal of Ophthalmology

JF - British Journal of Ophthalmology

SN - 0007-1161

IS - 9

ER -