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Intravitreal Pegaptanib in Ischemic CRVO Refractory Exudative Macular Detachment

Giovanni Cillino and Salvatore Cillino

Recent literature data reported evidence of the visual and/or anatomical benefits of all clinically available anti-VEGF drugs for the treatment of macular edema (ME) following Central Retinal Vein Occlusion (CRVO), up to 1-year followup. There are no randomized clinical trial data on anti-VEGF agents in ischemic CRVO-ME and the use of anti-VEGF agents to treat this condition.
A 73-year old caucasian man, with a medical history of diabetes and systemic hypertension and an ophthalmic history of ischemic CRVO with cystoid macular edema was referred to our division on January 2011. The ophthalmic examination showed in right eye a visual acuity of 20/2000, a C2N1 cataract and an exudative macular detachment. On February 2011, a 0.5mg ranibizumab intravitreal injection (Lucentis®, Novartis, Basel, Switzerland) was carried out in the right eye. 15 and 25 days later the OCT showed no changes. On March 2011, we performed a 0.3mg pegaptanib sodium intravitreal injection (Macugen, Eyetech Pharmaceuticals, Inc. and Pfizer Inc, New York, NY) in the right eye and 15 days later the fluorescein angiography and the OCT examination showed reabsorption of subretinal fluid, complete disappearing of macular detachment and normalization of foveal profile, with a thickness of 240 μm and visual acuity of 20/400. Three months later, foveal profile and visual acuity were unchanged.
In our refractory ischemic CRVO-ME patient, pegaptanib sodium showed prompt clinical response. In some cases, even if it is selective for the VEGF165 isoform only, pegaptanib sodium could represent a further possibility in such a therapeutic challenge.