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J. Jonisch, K. Blinder, G. K. Shah, A. C. Walsh; Anatomic Outcomes Using Spectral Domain OCT Following Treatment for Exudative Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4376.
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To assess anatomic differences in the photoreceptor layer and subretinal space using spectral domain OCT between patients undergoing monotherapy with ranibizumab versus combination therapy with verteporfin (reduced fluence PDT) plus ranibizumab.
This was a prospective study of 15 eyes with choroidal neovascularization secondary to age-related macular degeneration undergoing either three monthly ranibizumab injections (Group M) or reduced-fluence PDT plus prn ranibizumab. Spectral domain OCT was performed at 1 day, 1 week, weeks 2, 4, 8 and 12 weeks. Anatomic features were assessed by a masked reader at each of these time points.
At baseline, photoreceptor inner segment/out segment junction (IS/OS) was visible in 40% of patients (Group C: 38%, Group M: 43%) and at final visit the IS/OS junction was visible in 40% overall but higher in the combination group (Group C:50%, Group M: 29%; p>0.05). 50% of eyes in the combination group had an increase in subretinal fluid or intraretinal fluid at day 1 versus 0% in the monotherapy group (p=0.05). At week 1, 25% of eyes in Group C had subretinal or intraretinal fluid which resolved fully in each case by week 4.Average baseline visual acuity was 20/200 with a final visual acuity of 20/150 at three months. The average baseline vision of patients in Group C was 20/300 with a final vision of 20/200. The baseline vision of patients in Group M was 20/150 with a vision of 20/100 at the three month time point. Average number of ranibizumab injections in the combination group was 1.125 (range 1-2). All patients in the monotherapy group received three injections as scheduled
Photoreceptor structure assessed by spectral domain OCT at 12 weeks was not significantly different between the monotherapy and combination group. Reduced-fluence PDT may decrease possible deleterious effects to photoreceptors seen in the past. Combination therapy with Verteporfin plus ranibizumab may be associated with transient increase in subretinal and intraretinal fluid within 1 week therapy that resolves within 3-4 weeks.
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