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K. W. Small, R. Silva-Garcia; Combination Treatment With (PDT and Anti-VEGFs) for Wet AMD. Invest. Ophthalmol. Vis. Sci. 2008;49(13):553.
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While current anti-VEGF treatments for wet macular degeneration have been a major advance, the frequency and transitory effect of the intravitreal injections are an impediment for many patients and doctors. Similar to treating cancer, combination therapy may improve the effectiveness and longevity of the treatments. This could improve patient’s quality of life and be more cost effective.Purpose: To determine the effectiveness of combination therapy (PDT and anti-VEGFs) in treating wet AMD.
Consecutive retrospective chart review, with IRB consent, was performed on 95 consecutive eyes of 89 patients. There were no exclusion criteria. 20% of the eyes were treatment naïve. The data collected included visual acuity, OCT, IVFA and number of re-treatments. The baseline data were: Primarily occult lesions: 89%,Pigment epithelial detachment: 13%, Lesion size disc area: 4.61Greatest linear dimension (GLD) average: 3827 _m, Fibrosis: 59%, Average duration of lesion: 22 months, Average visual acuity, Logmar: 0.96 (20/200), Average optical coherence tomography (OCT) thickness: 353 microns. Re-treatment was done if there was any evidence of any activity of the CNVM.
At the 6 month follow-up: The OCT thickness had decreased to 265 (-88) microns, Visual acuity improved LogMar 0.89 (-0.07), 71% required no additional anti-VEGF injections, 21% required additional PDT. Adverse events were: 1 Visudyne infiltration,1 chest pain during PDT, 2 serous macular detachments, 1 bowel obstruction, 3 falls, no MI, no CVA, no deaths.
This case series showed that combination therapy was effective at improving vision and reducing CNV leakage: However, data are not directly comparable with previous studies (e.g. MARINA), as few of these patients would be eligible for such clinical trials. Combination therapy may result in decreased costs as the number of re-treatments required declines over time.
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