Treatment of choroidal neovascularisation in age-related macular degeneration with interferon alfa-2a and alfa-2b.

Abstract

Forty eight eyes of 42 patients with choroidal neovascular membranes and age-related macular degeneration who received three different dose regimens of systemic interferon alfa-2 were studied retrospectively. The A recent report suggests that systemic interferon alfa-2a treatment may inhibit the growth of choroidal neovascular membranes in eyes with age-related macular degeneration.6 Seven patients with well defined subfoveal membranes were treated with systemic interferon alfa-2a for about 6 weeks. Six patients showed resolution of the membrane on treatment, improved acuity, and smaller scotomas. The diameter of the choroidal neovascular membrane was one disc diameter (1 DD) or less in all six eyes in which the membrane regressed.Systemic interferon alfa-2 has been used clinically to treat vascular tumours, including pulmonary haemangiomatosis7 and haemangioendotheliomas.8 The antiangiogenic activity of interferon is not entirely understood. Interferon alfa inhibits vascular endothelial cell proliferation in vitro, possibly through the induction of 2',5'-oligoadenylate synthetase which leads to the degradation of viral and cellular RNA.9We present herein a retrospective analysis of 48 eyes of 42 patients with age-related macular degeneration who received systemic interferon alfa-2 (either 2a or 2b) treatment for active choroidal neovascular membranes. These patients were treated around the end of 1991 by several groups of Sydney ophthalmologists acting independently and using different protocols. The large number of patients treated no doubt reflects the public awareness of interferon alfa as a treatment for age-related macular degeneration, which was due to a number of reports in the media at that time. The goal of this study was to examine the effects of interferon alfa on the growth and activity of choroidal neovascular membranes in a large group of patients.

Pars plana vitrectomy for regression of choroidal neovascularization with age‐related macular degeneration

“…(ARMD) may be treated in several different ways, including photocoagulation (Macular Photocoagulation Study Group 1991Group , 1993Group , 1994Hawkins 1994), radiation therapy (Bergink et al 1994), pharmacologic therapy (Thomas & Ibanez 1993;Miller et al 1993;Gillies et al 1993;Chan et al 1994;Poliner et al 1994), and invasive intervention, such as a vitrectomy for the removal of subretinal hemorrhage (Ibanez et al 1995;Lewis 1995;Kamei et al 1996) or resection of choroidal neovascularization (CNV) (de Juan & Machemer 1988;Lambert et al 1992; Thomas et al 1992). Despite the merits of these procedures, photocoagulation of subfoveal CNV sometimes worsens visual acuity, radiation therapy is often complicated by a high incidence of recurrence, and pharmacologic therapy, such as interferon-å (Thomas & Ibanez 1993;Miller et al 1993;Gillies et al 1993;Chan et al 1994;Poliner et al 1994), often produces inconsistent results.…”

“…Despite the merits of these procedures, photocoagulation of subfoveal CNV sometimes worsens visual acuity, radiation therapy is often complicated by a high incidence of recurrence, and pharmacologic therapy, such as interferon-å (Thomas & Ibanez 1993;Miller et al 1993;Gillies et al 1993;Chan et al 1994;Poliner et al 1994), often produces inconsistent results. Pars plana vitrectomy to resect CNV has met with some success in recent years (de Juan & Machemer 1988;Lambert et al 1992; Thomas et al 1992).…”

Asymmetry of disciform scarring in bilateral disease when one eye is treated with radiotherapy.

“…18 We have shown in an animal model of perforating ocular injuries that focal radiotherapy limits the proliferation of granulation tissue and markedly reduces inflammatory cell recruitment. 19 We believe radiotherapy acts to minimise size and intensity of the disciform response through several pathways.…”

Radiation therapy in the treatment of exudative age-related macular degeneration

“…These alternatives include laser photocoagulation for CNV [56][57][58], submacular surgery especially in the setting of submacular hemorrhage [59,60], macular translocation [61], macular transplantation [62], and other antiangiogenic drug therapies such as IFN-a [63,64].…”