Purchase this article with an account.
F. Ziemssen, M. Völker, K. U. Bartz-Schmidt, F. Gelisken; Two-Year Experience of Sequential Therapy With Laser Photocoagulation and Intravitreal Bevacizumab for Extrafoveal Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2800.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the 24 months efficacy and safety of sequential intravitreal bevacizumab and laser photocoagulation for extrafoveal choroidal neovascularisation (CNV).
In this retrospective interventional pilot study, 9 eyes of 9 consecutive patients were treated with intravitreal bevacizumab (1.25 mg) one week after the laser photocoagulation of the extrafoveal well-defined CNV lesions. Intravitreal bevacizumab was repeated three times at 6-week intervals and thereafter if leakage was seen on the fluorescein angiography. Best corrected visual acuity (BVCA), fluorescein angiography and optical coherence tomography was performed at baseline and at 3 months follow-up visits. Primary outcomes were the BCVA and central retinal thickness (CRT).
In all patients (median age 74.7 years) a follow-up period of 24 months was available and the CNV was secondary to age-related macular degeneration. The average number of bevacizumab treatments fell from 3.6 injections (95%-CI: 2.9-4.2) during the first year to 1.7 retreatments (95%-CI: 0.0-3.4) after 12 months. Following the strict retreatment criteria, 5 of 9 patients did not receive any additional treatments in the second year. The mean logMAR BCVA was 0.34 at baseline and remained 0.29 between the 12-months and 24-months examination, respectively (P=0.677). Mean CRT decreased significantly from 223µm (baseline) to 179µm (12 month) and 163µm (24 month, P=0.03). The anatomic response was independent of the baseline acuity (Pearson coefficient: 0.529, P=0.14).
Two year results indicate that intravitreal bevacizumab in combination with laser photocoagulation is well tolerated. The necessity of retreatment and the recurrence rate do not seem to considerably differ from the reported response of subfoveal CNV to mono-therapy. It is not obvious that the combined laser treatment might enhance the outcome in extrafoveal well-defined CNV secondary to AMD. Larger controlled studies are needed for identify the potential of sequential laser photocoagulation and intravitreal bevacizumab injection for the treatment of extrafoveal CNV.
This PDF is available to Subscribers Only