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S. Chen, L.-I. Lau, A.-F. Li, Y.-T. Liu, F.-L. Lee; Combination Therapy for Choroidal Neovascularization Due to Age-Related Macular Degeneration - Reduced Fluence Photodynamic Therapy and Intravitreal Avastin. Invest. Ophthalmol. Vis. Sci. 2008;49(13):551.
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To evaluate the efficacy and safety of combination therapy with reduced fluence photodynamic therapy and intravitreal Avastin in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
Nineteen eyes in 17 consecutive patients with CNV due to AMD were treated with 6mg/m2 Visudyne and reduced fluence of light application for 43 seconds followed by intravitreal injection of Avastin of 2.25mg/0.1 ml. Best-corrected visual acuity in ETDRS letters and optical coherent tomography (OCT) of central foveal thickness were followed monthly for at least 3 months in this prospective, non-comparative interventional case series. Endpoint was reached when retreatment with additional Avastin was indicated according to the following criteria of: 1. recurrent CNV as shown in fluorescein angiography; or 2. increased retinal hemorrhage in fundus examination; or 3. increased retinal thickness or persistent subretinal fluid for more than 3 months.
At 1 month after combination therapy, all the CNV were occluded as well as the improved absorption of subretinal fluid and the effect were lasted for at least 3 months. There were 2 eyes (10.5%) with recurrent CNV at 4 months that had to be retreated with intravitreal Avastin. The visual acuity improved from baseline 28.9+20.4 to final 36.8+23.4 letters (paired t-test, p=0.001) after mean 5.3 (4 to 8) months follow up. The central foveal thickness improved from preoperative 353.1+83.2 um to final 180.0+37.1um (paired t-test, p<0.001).
Combination therapy with reduced fluence PDT and intravitreal Avastin can improve the visual acuity significantly and the effect maintained for at least 4 months. These results need to be confirmed by longer follow up and larger control trial.
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