INTRAVITREAL ANTI-VEGF FOLLOWED BY PHOTODYNAMIC THERAPY VERSUS ANTI-VEGF MONOTHERAPY FOR RETINAL ANGIOMATOUS PROLIFERATION

Abstract

 

Purpose

 

To compare the efficacy of intravitreal anti-vascular endothelial growth factor (VEGF) plus photodynamic therapy (PDT) vs anti-VEGF monotherapy in retinal angiomatous proliferation (RAP).

 

Methods

 

54 eyes of 48 consecutive patients with newly diagnosed RAP were enrolled in this retrospective interventional study. Group 1 (27 eyes) received combo therapy, group 2 (27 eyes) received anti-VEGF monotherapy. Patients received ranibizumab (0.5 mg/0.05 ml) or bevacizumab injections (1.25 mg/0.05 ml) depending on visual acuity (Italian Healthcare Policy provide ranibizumab if best corrected visual acuity is ≥ 0.2). A course of combination therapy (Group 1) consisted of one anti-VEGF injection and single session of standard verteporfin PDT within 10 days. Spot size was minimized to RAP lesion visible in indocyanine green angiography (ICGA). Group 2 received 3 monthly injections of anti-VEGF monotherapy. Best corrected visual acuity (BCVA) with ETDRS charts, complete eye examination including digital dynamic fluorescein and indocyanine green angiography (Heidelberg Engineering) and mean foveal thickness (MFT) using optical coherence tomography (OCT) (Stratus III OCT, Zeiss) were performed at baseline and after 3, 6, 9 and 12 months. Retreatment criteria, with the same therapeutic scheme in each group, were worsening of BCVA and/or deterioration of angiographic or OCT findings.

 

Results

 

Mean BCVA was stable in Group 1 and worsened at the 12-month in Group 2 (+0.177 LogMar) (P<0.0002, ANOVA). The MFT decreased significantly in both groups (mean change -68 µm in Group 1, -140 µm in Group 2) (P<0.0001, ANOVA).

 

Conclusions

 

RAP is a distinct form of exudative AMD with a very poor natural course without an established treatment. In our study combination therapy is more effective than anti-VEGF monotherapy. These findings also suggest a possible benefit of combination therapy in the rate of intravitreal re-injections.

 

Keywords: 700 retinal neovascularization • 647 photodynamic therapy • 748 vascular endothelial growth factor