Abstract
Purpose: :
To investigate the correlation between change in visual acuity and lesion size after photodynamic therapy (PDT) combined intravitreal triamcinolone or bevacizumab for age-related macular degeneration (AMD) with classic choroidal neovascularization.
Methods: :
Subjects comprised 46 AMD patients (47 eyes) treated by PDT in the Department of Ophthalmology at Osaka City University between October 2004 and July 2008, for whom at least 1 year had elapsed since treatment. There were 32 male eyes and 14 female eyes. Mean patient age was 73.5 years (range, 54-86 years). PDT alone was performed in 16 eyes (PDT alone group), 21 eyes were treated with combined intravitreal triamcinolone (IVTA-PDT group), and 10 eyes with combined intravitreal bevacizumab (IVB-PDT group).Changes in visual acuity before and 1 year after PDT were investigated, with decimal visual acuity converted to logMAR visual acuity. We compared the greatest linear dimensions of classic lesions only (C-GLD) on fluorescein angiography between before and 3 months after PDT. In addition, we examined the correlation of the change in C-GLD with visual acuity.
Results: :
Change in mean logMAR visual acuity before and after 12 months PDT was 0.77 to 0.76, 0.86 to 67, and 0.63 to 0.33 in the PDT alone, IVTA-PDT, and IVB-PDT groups, respectively; visual acuity was significantly improved in the IVTA-PDT and IVB-PDT groups (PDT alone group: P=0.80; IVTA group: P<0.01; and IVB group: P<0.01, Wilcoxon signed-ranks test). Pretreatment mean C-GLD was 2501.6 µm, 2544.1 µm, and 2134.2 µm in the PDT alone, IVTA, and IVB groups, respectively, and the percentage reduction in C-GLD after 3 months was -9.1%, -32.4%, and -23.3%, respectively; C-GLD were significantly reduced in size in the IVTA-PDT and IVB-PDT groups (PDT alone group: P=0.06; IVTA-PDT group: P<0.001; IVB-PDT group: P<0.01, paired t-test). A correlation was observed in the change in visual acuity after 1 year with the percent reduction in C-GLD after 3 months (r=0.46, P<0.01, single regression analysis).
Conclusions: :
Combined IVTA or IVB is more effective than PDT alone on classic lesions and change in C-GLD after 3 months PDT was useful for visual prognosis.
Keywords: age-related macular degeneration • photodynamic therapy • vascular endothelial growth factor