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Colleen M. McLellan, Rosemary Silva-Garcia, Kent Small; Long-Term and Lasting Outcomes of Combination Treatment for Age-Related Macular Degeneration with Photodynamic Therapy and Intravitreal Injection of Anti-Vascular Endothelial Growth Factor. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4509. doi: https://doi.org/.
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Age-related macular degeneration is the leading cause of blindness in the United States. Combination anti-VEGF injection with Photodynamic Therapy (PDT) may have sustainable positive results, mitigating risks and costs of regular injections. A retrospective chart review of patients who responded to a final combination treatment and required no further treatment was performed in order to find possible predictive characteristics for this positive response.
We reviewed the charts of all exudative AMD (26 patients, 33 eyes) from a retina specialty practice in Los Angeles and Glendale, California for whom combination treatment with anti-VEGF drug and PDT effectively halted for over a year the progress of choroidal neovascular membranes (CNVM). Characteristics recorded in each study eye were uni- or bilateral disease, CNVM change, age at first signs of disease, gender, and changes in visual acuity, retinal thickness, and intraocular pressure.
Median visual acuity prior to combination therapy was 20/300. This improved to 20/200 and stabilized for years 1-4 after effective treatment. Median duration of prior treatment was 10.5 months, with a median of 3 anti-VEGF injections and 1 PDT. Macular thickness as determined by OCT decreased in years 1, 3, and 4. We did not find predictive characteristics in these patients. Most notably, whether wet AMD was bi - or unilateral seemed to have no bearing, nor did use of anti-coagulants. We found no significant change in intraocular pressure in the study period. The other data parameters such as age at first signs of disease, gender, and smoking and family history did not present a notable trend. No patients experienced any of the standard, serious complications of the anti-VEGF therapy or PDT.
Combination therapy (PDT with anti-VEGF) can result in long lasting closure and control of the CNVM. This appears to limit exposure to complications of regular, repeated anti-VEGF therapy. This data did not find predictive characteristics for the success of combination therapy. Values for data points were typically evenly distributed across their range, indicating that these alone do not predict success of this approach to exudative AMD. The data collection and analysis methods provide a framework for further study.
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