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F. Gelisken, F. Ziemssen, M. Völker, K. U. Bartz-Schmidt; Sequential Therapy With Laser Photocoagulation and Intravitreal Bevacizumab for Extrafoveal Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2009;50(13):186.
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To evaluate the efficacy and safety of sequential intravitreal bevacizumab and laser photocoagulation for extrafoveal choroidal neovascularisation (CNV).
In this retrospective interventional pilot study, 9 eyes of 9 consecutive patients were treated with intravitreal bevacizumab (1.25 mg) one week after the laser photocoagulation of the extrafoveal well-defined CNV lesions. Intravitreal bevacizumab was repeated three times at 6-week intervals and thereafter if leakage was seen on the fluorescein angiography.Best corrected visual acuity (BVCA), fluorescein angiography and optical coherence tomography was performed at baseline and at 3 months follow-up visits. Primary outcomes were the BCVA and central retinal thickness (CRT)
Median age of the patients (6 female, 3 male) was 74.7 years. In all patients a follow-up period of 12 months was available. CNV was secondary to age-related macular degeneration in all eyes. Average number of bevacizumab injections was 4.1 (range 3 to 8). Mean logMAR BCVA was 0.34 at baseline and 0.29 at the 12-months examination, respectively (P=0.559). Mean CRT decreased significantly from 223µm (baseline) to 179µm to (12 month, P=0.024). The anatomic response was independent of baseline visual acuity Pearson coefficient: 0.329, P=0.387). In 4 eyes further bevacizumab treatment was needed because of the leakage due to the persistent and/or recurrent CNV. Only in one eye subfoveal recurrent CNV developed. No systemic side effects were observed. In one eye recurrent vitreous haemorrhage developed that resolved spontaneously.
One year results indicate that intravitreal bevacizumab in combination with laser photocoagulation is well tolerated and associated with improvement or stabilisation in BCVA and reduced angiographic leakage in most eyes with extrafoveal well-defined CNV secondary to AMD. Larger controlled case series are needed for identify the role of sequential laser photocoagulation and intravitreal bevacizumab injection for the treatment of extrafoveal CNV.
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