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B. P. Connolly, S. J. Rose, E. Guillet; Long Term Results of Combination Therapy for Exudative Age Related Macular Degeneration Using Intraocular Bevacizumab and Photodynamic Therapy With Visudyne: A Consecutive Case Series. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4555.
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© ARVO (1962-2015); The Authors (2016-present)
Collection of visual outcomes of a consecutive series of patients with exudative macular degeneration treated with intraocular bevacizumab (IOB) in combination with photodynamic therapy using verterporfin (PDT).
Patients treated with IOB and PDT in "combination" (≤ 30 days apart) were identified. An IRB approved chart review was conducted. Snellen visual acuities, recorded from the baseline exam, the most recent follow-up and prior to each treatment intervention (IOB or PDT), were converted into logMAR units for statistical purposes. Baseline characteristics such as gender, lesion composition, presence or absence of fibrosis, and presence or absence of hemorrhage were recorded.
A group of 183 patients were followed for a mean of 191 days from the onset of "combination" therapy until the most recent examination. Overall, the mean visual acuity improved from 20/157 (0.895 logMAR units) to 20/124 (0.794 logMAR units) at the last visit. This represented a gain of 5 ETDRS letters (95% CI 1.15 to 8.92, n=183). Sub-group analysis demonstrated that patients with fibrosis (n=51) started with a mean acuity of 20/412 (1.314 logMAR units) and dropping slightly to 20/415 at the last visit (1.317 LogMAR units). In contrast, patients without fibrosis improved from 20/108 (0.734 logMAR units) to 20/78 (0.593) with a mean gain of 7.0 ETDRS letters (95% CI 2.55 to 11.52, n=132). Patients who were treatment naïve and no fibrosis gained a mean 8.6 ETDRS letters (95% CI 2.1 to 15.10 letters, n=82) with an initial mean acuity of 20/114 (0.758 logMAR units) and a final acuity of 20/77 (0.586 logMAR units). When the IOB preceded the PDT, the mean change in vision was -0.8 ETDRS letters (95% CI -11.63 to 9.94). In contrast, with same day combinations or when PDT preceded the IOB, patients gained a mean of 6.6 ETDRS letters (95% CI: 2.53-10.62 letters). Patients required an average of 1.35 PDT treatments and 2.09 IOB treatments as of the last recorded visit.
In this consecutive case series, combination therapy with PDT and IOB led to a mean vision gain in patients without fibrosis. When the IOB preceded the PDT, vision gains may have been less favorable. Patients that were treatment naïve and who had no fibrosis experienced the most significant vision gain.
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