Abstract
Purpose: :
To compare visual acuity (VA) outcomes in daily practice after primary photodynamic therapy (PDT), intravitreal ranibizumab (IVR), intravitreal bevacizumab (IVB) or no therapy in patients with subfoveal choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD).
Methods: :
We reviewed the clinical records of 473 consecutive patients (473 eyes) in this retrospective, multicenter, follow up study. Patients in the natural history group were selected if diagnosed between 1992 and 1997. Patients were included if the diagnosis of subfoveal CNV due to AMD was confirmed by fluorescein angiography (FA) and for the intervention groups had at least one treatment. We excluded patients if they had participated in an ophthalmic clinical trial. At each visit VA, ophthalmic examination, FA and/or treatment were recorded if available. Linear mixed models were used to compare the one year change in VA between the natural history, PDT, IVR and IVB. The natural history group was used as reference. We adjusted the data for baseline visual acuity, gender, age, size and type of lesion on FA.
Results: :
The natural history, PDT, IVR and IVB group consisted of 102, 138, 103 and 130 patients respectively. The mean age of our patients was 78.4 (SD 7.3), 55% were women, the baseline VA was 0.76 (SD 0.43) in logarithm of the minimum angle of resolution (logMAR)) and the mean follow up was 3.2 (SD 2.7) years. Of the patient population 43%, 37% and 13% had predominantly classic, occult and minimally classic CNV lesion respectively (7% could not be classified).IVR and IVB had significantly better VA outcomes compared to the natural history group after 12 months of follow up. The difference between VA outcomes of PDT and natural history was not statistical significant after 12 months of follow up. The estimated one year changes of VA were 0.16, 0.17, 0.46, 0.52 logMAR for IVR, IVB, PDT and natural history respectively. The mean number of treatments of IVR, IVB and PDT per eye were respectively 4.3 (range 1-10) 3.7 (range 1-9) and 1.9 (range 1-6) at 12 months.
Conclusions: :
In daily practice primary IVR and IVB had statistically significant better VA outcomes compared to natural history after 12 months. No statistically significant differences were found for VA outcomes between primary PDT and natural history. Also, no statistically significant differences in VA outcomes were seen for IVR and IVB.
Keywords: age-related macular degeneration