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S.A. Ebrahim, G.A. Peyman, M.D. Conway, R. Ratnakaram, S. Bhavan, I.–S. Kwon, M. Khan; Combination Photodynamic Therapy and Argon Grid Photocoagulation for the Treatment of Classic and Occult Choroidal Neovascularization Secondary to Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3096.
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Purpose: To report the visual outcomes, retreatment rates, and complications of a combination treatment of argon macular grid photocoagulation and photodynamic therapy (PDT) with verteporfin for exudative age–related macular degeneration (ARMD). Methods: PDT followed by a broad macular grid of argon photocoagulation was applied to 77 eyes with choroidal neovascularization (CNV) associated with ARMD. Initial visual acuities ranged from 20/20 to counting fingers, and all combinations of CNV subtypes were included. Retreatments were applied as deemed clinically and angiographically necessary. Results: One year after treatment, 92% of followed eyes lost less than 3 lines of vision, and 42% gained one or more lines of vision. Two years after treatment, 75% of followed eyes lost less than 3 lines, and 25% gained one or more lines. Only 12% of eyes in this study required retreatment; an average of 1.1 treatments was administered for all eyes. No iatrogenic CNV was noted in the 77 treated eyes. Conclusions: Combination PDT and argon macular grid laser treatment may offer significantly improved visual outcomes in exudative ARMD over PDT alone for all follow–up intervals up to 2 years. This treatment combination may lower retreatment rates significantly for up to 2 years posttreatment. This combination of photocoagulation and PDT may be particularly well suited for the prevention of iatrogenic CNV from all macular photocoagulative treatments. Further statistical evaluation of the current data, and a review of all angiographic imaging for formal categorization of lesions into classic, occult, minimally classic, and predominantly classic subgroups will enhance the potential for meaningful interpretation of the data compiled. A larger controlled, masked prospective study of this combination treatment modality may be warranted. These findings also merit further study of the protective effect of PDT against iatrogenic photocoagulation–induced CNV.
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