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S. W. Cousins, K. G. Csaky, Ophthotech Study Group; Patterns of CNV Fluorescein and Indocyanine Green Angiographic Regression Responses After Anti-VEGF Monotherapy or Anti-VEGF Plus Anti-PDGF Combotherapy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1261.
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© ARVO (1962-2015); The Authors (2016-present)
Anti-VEGF monotherapy for neovascular AMD (NVAMD) typically causes stabilization of CNV lesion size and leakage. Development of anti-PDGF pegylated aptamer (Ophthotech E10030) is based on using targeted combination therapy to regress CNV by simultaneously blocking angiogenesis with anti-VEGF and "stripping away" the pericytes from the incipient vessel with anti-PDGF. We sought to compare the fluorescein angiographic (FA) and dynamic indocyanine green angiographic (ICGA) patterns of CNV regression responses in eyes receiving either anti-VEGF monotherapy with or without anti-PDGF combotherapy.
A retrospective review was performed of 20 cases of NVAMD in which 2-3 doses of intravitreal anti-VEGF monotherapy successfully induced anatomic improvement by OCT. These eyes were compared to 13 eyes of patients in a phase 1 study of combotherapy with monthly intravitreal ranibizumab (up to 3 doses) plus intravitreal anti-PDGF aptamer (at least one but up to 3 doses). Eyes were imaged by FA pretreatment and at various times post treatment. Many eyes were also imaged by dynamic ICGA (Spectralis, Heidelberg). Angiograms were evaluated to assess the changes in lesion size and vascular perfusion.
Three angiographic patterns of "OCT successful" responses to treatment were observed. (1) Stable inactivity was characterized by FA with stable lesion size and uniform low grade fluorescein hyperfluorescence (staining) of the CNV. ICGA typically demonstrated persistence of feeder arteries with branching arterioles. (2) Vascular regression demonstrated FA with stable CNV area but shrinkage of area of fluorescein staining. ICGA demonstrated disappearance of homogenous capillaries and small branching arterioles. (3) Lesion regression was characterized by partial to nearly complete disappearance of both the CNV lesion and hyperfluorescent staining. Persistent hypofluorescence in the bed of the CNV was often present. ICGA revealed significant disappearance of most vascular components. Partial or extensive lesion regression occurred in 85% (11 of 13 eyes) treated with anti-PDGF combotherapy compared to only 20% (4 of 20 eyes) treated with anti-VEGF monotherapy. In contrast, stable inactivity was observed in only 15% (2 of 13 eyes) treated with combotherapy versus 55% (11 of 20 eyes) treated with anti-VEGF monotherapy.
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