Faculty Bibliography

BACKGROUND: Controversy exists as to whether a common causal entity is responsible for multifocal choroiditis (MFC) and multiple evanescent white dot syndrome (MEWDS). It is commonly known that patients with MEWDS can later develop manifestations of MFC, but the reverse is rarely seen. PURPOSE: To report cases of MEWDS in patients previously diagnosed with MFC. DESIGN: Retrospective case series. PARTICIPANTS: Four female patients 29 to 34 years old. METHODS: The charts of four patients with acute unilateral onset of MEWDS and evidence of previous MFC were examined retrospectively. MAIN OUTCOME MEASURES: Photographic and angiographic interpretation of fundus appearance. RESULTS: At the time of diagnosis with typical MEWDS, one patient had a documented previous episode of acute MFC; one patient had previous bilateral choroidal neovascularization associated with discrete, posterior atrophic scars; and two patients had peripheral discrete chorioretinal pigmented lesions and peripapillary atrophy. CONCLUSIONS: MEWDS may occur after MFC. Now that both directions of disease progression, MFC to MEWDS and MEWDS to MFC, have been well documented, it is likely that there is a common host susceptibility between these two distinct clinical diseases, if not a common pathogenesis

Background: Recent studies have suggested that vascular endothelial growth factor (VEGF) is an important stimulus for the growth of new blood vessels in the eye. Anti-VEGF therapy is thus a potential treatment for exudative macular degeneration and diabetic retinopathy. Methods: Previously described animal models of vascular leakage and ocular neovascularization, including the Miles assay, the rat corneal angiogenesis model, and the mouse retinopathy of prematurity (ROP) model, were used to study this drug. After these studies, a phase IA single ascending dose study of intravitreal injections of the drug was performed in 15 patients with subfoveal choroidal neovascularization secondary to exudative age-related macular degeneration (AMD). Results: The Miles assay model showed almost complete attenuation of VEGF-mediated vascular leakage following addition of EYE001, and the corneal angiogenesis model also showed a significant reduction in neovascularization with EYE001. The ROP model showed inhibition of 80% of the retinal neovascularization compared with controls (P = 0.0001). The phase A safety study of patients with exudative AMD showed no significant safety issues related to the drug. Ophthalmic evaluation revealed that 80% of patients showed stable or improved vision 3 months after treatment and that 27% of eyes demonstrated a three-line or greater improvement in vision on the Early Treatment for Diabetic Retinopathy Study chart at this time. Conclusion: Anti-VEGF therapy is a promising new avenue for the treatment of neovascular diseases of the eye, including exudative macular degeneration and diabetic retinopathy. Preclinical data from studies with EYE001 support clinical evaluation of its efficacy in such diseases. This report is the first to describe administration of anti-VEGF therapy in humans for exudative macular degeneration and shows the safety of such therapy for single injections. Further clinical studies are necessary to determine the safety of multiple intravitreal injections of EYE001 and larger studies are needed to prove the efficacy of this novel, potentially therapeutic agent for neovascular AMD