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Purpose:

To investigate the role of Procrit intravitreal injections in stabilizing vision and geographic atrophy (GA) in eyes with atrophic AMD and to characterize SD-OCT and central visual field acuity perimetry (Omnifield) findings associated with GA.

Methods:

A retrospective pilot study examined eyes treated off-label with Procrit 10U injected intravitreal every 6 weeks. Photographed GA areas (identified on autofluorescence and fluorescein angiograms) were manually outlined and the area converted to mm2 using the OCT caliper. SD-OCT images were analyzed for loss of PR ellipsoid-segment, loss of ONL, and RPE thickening. Primary outcomes were the effect of treatment on GA enlargement rate and Omnifield Fixation Acuity, Best acuity in 6 degrees of fixation and Global Macular Acuity (weighted average of threshold acuities within 10° of fixation). GA enlargement rate was also compared between treated eyes and fellow untreated eyes with similar GA.

Results:

32 eyes of 28 patients were treated for 1.6±0.8 years with 12±6.2 injections. Eyes were followed for 0.75±0.36 years prior to treatment with average initial GA area of 10.2±7.0mm2. Treatment reduced the rate of GA enlargement by 0.67±0.2.0mm2/y (56%) from 2.55±3.8 mm2/y prior to treatment. In 24 untreated fellow eyes, GA enlargement was 2.25±0.89mm2/y, or 0.32±0.38mm2/y larger than in treated eyes. In the treated eyes visual acuity over the term improved by an average 0.1 LogMAR +/-0.30 LogMAR with no significant difference from the fellow untreated eyes. Omnifiled GMA improved 0.16±0.09 LogMAR during treatment compared with a loss of 0.05±0. prior to treatment. GA was described by OCT loss of PR ellipsoid segment junction and ONL. Indicators of future GA progression were loss of ONL and RPE thickening at the margins. Central acuity visual field scotomas corresponded with loss of PR ellipsoid segment.

Conclusions:

In this off-label study, intravitreal Procrit® appears to slow progressive GA expansion and vision loss in AMD. Acuity perimetry and OCT are useful for mapping areas of preserved vision, monitoring disease progression, and predicting future GA enlargement.