Foveal geographic atrophy following intravitreal pegaptanib sodium (Macugen) for drusenoid pigment epithelium detachment

PURPOSE. To describe a patient with nonexudative age-related macular degeneration (AMD) who underwent intravitreal pegaptanib sodium injection for drusenoid pigment epithelium detachment (PED). METHODS. A 66-year-old woman, who underwent intravitreal pegaptanib sodium injection in her right eye ( RE) for chronic serous drusenoid PED, was submitted to a complete ophthalmologic examination, including fundus biomicroscopy, fluorescein angiography ( FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT-3, Humphrey-Zeiss, San Leandro, CA), 3 days and 1 month after the treatment. RESULTS. Three days after the intravitreal pegaptanib sodium injection, best-corrected visual acuity (BCVA) was 20/32 in the RE. One month later, the patient's BCVA dropped to 20/200 in the RE. Interestingly, fundus biomicroscopy, FA, OCT, and ICGA revealed the development of foveal geographic atrophy. Fundus-related perimetry (MP-1 Micro Perimeter, Nidek Technologies, Padova, Italy) revealed an eccentric and unstable fixation within 2 degrees with central absolute scotoma and pericentral diffuse reduction of sensitivity. CONCLUSIONS. The rapid development of foveal geographic atrophy in our patient may be related to the antivascular endothelial growth factor treatment, in part because of the reduced neuroprotective effect, and in part because of the adjunctive decreased blood flow in an already imbalanced foveal choroidal circulation due to AMD complicated by chronic serous drusenoid PED. (Eur J Ophthalmol 2009; 19: 890-3)