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F. Ziemssen, W. Inhoffen, M. Voelcker, S. Grisanti, P. Szurman, K. U. Bartz-Schmidt, Tuebingen Bevacizumab Study Group, F. Gelisken; Intravitreous Bevacizumab Monotherapy vs. Combined Therapy (Bevacizumab + PDT) of Choroidal Neovascularization in Pathological Myopia: Outcome and Re-Treatment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3397.
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Frequent recurrences often account for the severe vision loss of the young patients suffering from myopic choroidal neovascularization. Promising short-term results of anti-VEGF treatment (intravitreal injection of bevacizumab [AvastinTM]) have recently been published; in total, follow-up of 22 eyes has been described. To compare the intravitreous bevacizumab treatment (IBT) with combined therapy of intravitreous bevacizumab injection and verteporphin photodynamic therapy (B-PDT), clinical outcome of both treatments was analyzed in choroidal CNV secondary to pathologic myopia.
In a non-randomized, retrospective interventional case-series 15 patients (15 eyes) received intravitreal bevacizumab (1.25mg) whereas 10 patients (10 eyes) were treated by bevacizumab injection following photodynamic therapy (PDT) with verteporphin [VisudyneTM]. Regular control examinations included best-corrected ETDRS score, ocular coherence tomography [OCT3, Zeiss] and fluorescence angiography. Indication for re-treatment was adopted from the PrONTO study with loss of 5 letters in the presence of leakage, increase in retinal thickness of more than 100µm or signs of CNV activity as bleeding or increase in CNV size. The median follow-up was 239 days (CI-95%: 193-272 days).
Mean visual acuity improved in both treatment groups showed an increase in EDTRS score of 3.3 letters (CI-95%: -4.0 - 10.6) in the IBT group vs. 3.2 letters (CI-95%: -5.1 - 11.5 ) in the B-PDT group. Retinal thickness at the final examination correlated with visual acuity (Pearson coefficient, IBT: -0.534 vs. B-PDT: -0.616).Eleven of the 15 patients received re-treatment in the IBT group. Four of the 10 patients have been given further bevacizumab injections in the B-PDT group. If anti-VEGF therapy was repeated, the intervals between the injections were similar in both treatment groups (p= 0.62, IBT CI-95%: 109-200d; B-PDT CI-95%: 77-181d).
There might be an advantage of using anti-VEGF therapy in combination with PDT as the frequency of necessary re-treatment was significantly lower. Despite its limitations in myopia, OCT measurement seemed to provide additional predictive information in estimating the need for re-treatment. Good short-term results were seen in both treatment groups. However, analysis of larger controlled studies is suggested to statistically weight the functional outcome for other potential factors as lesion size and fixation behavior.
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