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S. Marchi, P. Ramolfo, E. Mantovani, E. Marziani, G. Staurenghi; Combined Use of Anecortave-PDT versus Combined Use of Avastin-PDT in the Treatment of Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1919.
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evaluate the difference between subtenon injection of Anecortave and intravitreal injection of Avastin, both combined with photodynamic treatment (PDT), in the treatment of retinal angiomatous proliferation (RAP).
In the period between June 2006 and January 2007, 30 patients with naif RAP lesion were enrolled in a prospective study. All the patients were randomly assigned to two groups (15 patients for each), in order to receive subtenon injection of Anecortave (group 1) or intravitreal injection of Avastin (group 2), both followed by PDT after 15 days, for a period of 18 months. Follow-up visits were scheduled every month. The treatment outcomes were evaluated using visual acuity (ETDRS charts), fluorescein angiography (FA) and dynamic indocyanine green angiography (ICGA). The decision for retreatment was based on worsening of leakage on angiography and/or decreased visual acuity (VA). Retreatment protocol included a PDT every three months and the possibility to repeat Avastin every month, and Anecortave every six months. If the lesion kept worsening after the second follow-up control (after 2 months) the patient drooped out from the study and changed treatment.
because of clinical worsening in both groups, 3 patients from group 1 and 5 from group 2 drooped out before 6 months. Five patients of group 1 drooped out before 18 months and 4 from group 2. Six patients of Avastin group and 7 of Anecortave group received a follow-up of 18 months. At six months of therapy, in the first group 3 patients demonstrated a functional improvement in their VA (≥ 2 lines) , 5 patients demonstrated a steady state, and 4 patient demonstrated a worsening in VA ( ≤ 2 lines) . In the second group 4 patient demonstrated an improvement, 3 demonstrated a steady state and 3 demonstrated a worsening in VA (≤ 2 lines). At the 18 months only one patient for each group had a good outcome with an improvement of visual acuity (≥ 2 lines) while the others subjects had a worsening (final VA ≤ 2 lines of initial VA). Anatomically, all the initial RAP lesions evolved in scar tissue. There was no statistical difference in VA outcomes between the two groups (ANOVA p>0.05).
although in the first six months of treatment with Anecortave or Avastin an improvement/steady state of the visual function was seen, after 18 months of follow-up all the patients demonstrated a worsening of their symptoms. Moreover, there did not seem to be a difference in the outcomes results between the two groups, even if this finding could be due to the few number of patients enrolled.
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