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L. Chen, I. Kim, D. Vavvas, J. Miller; Intravitreal Anti-VEGF Monotherapy versus Combination With PDT for Subfoveal Choroidal Neovascularization Secondary to Causes Other Than Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2212.
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To compare the visual outcomes and retreatment rates of intravitreal injection of anti-VEGF monotherapy verse combination with PDT on choroidal neovascularization (CNV) secondary to causes other than age-related macular degeneration (AMD)
We included 23 patients with subfoveal CNV due to causes other than AMD treated at MEEI retina service from 2006 to 2008. Seventeen patients received intravitreal injection of 1.25mg bevacizumab, and six patients underwent intravitreal anti-VEGF treatment combined with verteporfin PDT within 3 days. Additional intravitreal injections of anti-VEGF were administrated if there were persistent fluorescein leakage from the CNV or subretinal fluid on OCT.
At six-months after treatment, 88% and 100% lost fewer than 2 lines of vision or gained vision in the monotherapy and combo groups, respectively. Gain of more than 3 lines of vision occurred in 29% in the monotherapy group and 33% in the combo group. At one year after treatment, 93% in the monotherapy group and 100% in the combo group lost fewer than 2 lines of vision; 36% gained more than 3 lines of vision in anti-VEGF alone group compared to 60% in the combo group. The retreatment rates were 4.8 and 2.6 in monotherapy and combo groups over 12 months, respectively. Subgroup analysis of cases of CNV due to pathologic myopia demonstrated that retreatment rate were 3.4 in monotherapy group and 1.3 in combo group (P=0.047) at 6-month follow-up, and 7.2 and 2 in monotherapy and combo group, respectively (P=0.0498) at 12-month follow-up.
The majority of patients had stabilization or visual gain in both treatment groups. Combination therapy of intravitreal bevacizumab with PDT showed lower retreatment rates in patients with myopia. Randomized clinical trials are necessary to confirm these findings.
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