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Kevin R. Tozer, Lawrence Chong, Srinivas R. Sadda; Rescue Therapy With Combined Anti-vegf And Pdt For Refractory AMD. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1671.
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Examine the efficacy of combination anti-VEGF and photodynamic therapy for the treatment of neovascular AMD refractory to anti-VEGF monotherapy.
Retrospective interventional study. Study patients consisted of a subset of all patients treated at the VMR Institute and the Doheny Eye Institute with anti-VEGF monotherapy for neovascular AMD and considered treatment failures between January 1, 2009 and December 30, 2010. Treatment failure was defined as persistent subretinal or intraretinal fluid after at least 3 anti-VEGF injections in the 7 months prior to combination treatment. Combination treatment consisted of anti-VEGF intravitreal injection followed 7 to 14 days later by half fluence photodynamic therapy. Primary outcome measure was resolution of subretinal or intraretinal fluid by spectral domain OCT. Secondary outcome measures were visual acuity and frequency of repeat treatments with anti-VEGF monotherapy or combination therapy. All patients had at least 3 months of follow-up at time of abstract submission.
Nine eyes from nine patients were included in this study. Mean follow-up was 9.2 months (3-20 months). These patients received a mean of 5.3 injections (35 lucentis, 13 avastin) within the 12 months prior to declaration of treatment failure. After rescue combination therapy, a mean of 1.9 retreatments were administered (13 lucentis, 6 avastin, 4 combination retreatments). At one month after combination treatment, subretinal or intraretinal fluid resolved completely in 4 eyes, improved in 3 eyes and was unchanged in 2 eyes. Mean visual acuity was .85 logmar (20/140) before rescue therapy, .70 (20/100) at one month, and .75 (20/100-2) at 3 months. The mean interval between injections increased from 2.3 months to 3.89 months after combination therapy.
Rescue therapy with the combination of Anti-VEGF and PDT is effective for eyes which fail Anti-VEGF monotherapy. Most patients experienced a decrease in subretinal fluid, improvement in visual acuity, and longer period between injections after patients receive combination therapy. Larger studies are needed to confirm these results.
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