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C. C. Claudio, M. J. Potter; Combination Verteporfin PDT and Bevacizumab as Rescue Therapy Following Bevacizumab Monotherapy in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):555.
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To determine the clinical outcomes of rescue therapy with combination verteporfin photodynamic therapy and intravitreal bevacizumab following monotherapy with bevacizumab alone in patients with neovascular age-related macular degeneration (AMD).
A retrospective chart review of 46 eyes of 44 consecutive patients treated with intravitreal bevacizumab (1.25 mg) monotherapy and subsequently treated with combination reduced-fluence verteporfin PDT (300 mW/cm2) and intravitreal bevacizumab, primarily because of poor response to monotherapy. Eyes (1) relapsing following cessation of monotherapy; (2) requiring multiple treatments; or (3) with persistent cystoid edema on optical coherence tomography (OCT) were included. Ocular exam and OCT were performed at baseline and follow-up visits. Visual acuity was measured at each visit using ETDRS charts, with patients wearing their habitual corrections. Follow-up ranged from 7.5 to 21 months, mean 16.6 months.
Combination verteporfin PDT and bevacizumab was initiated following a mean of 4.2 injections of bevacizumab alone over the course of 9.8 months on average in the 46 eyes studied. Mean visual acuity was 20/100-1 at both the initial bevacizumab monotherapy visit and the initial combination therapy visit. Patients were followed for a mean of 6.8 months after the initial combination treatment and received a mean of 0.4 combination treatments and 1.0 bevacizumab injections over the follow-up period. After one combination treatment, 33% (15/46 eyes) did not require further treatment; 30% (14/46 eyes) were treated with one or two more injections of bevacizumab alone; 28% (13/46 eyes) were treated with both combination therapy and bevacizumab monotherapy; 7% (3/46 eyes) were treated with one more combination treatment but no further bevacizumab monotherapy; and 2% (1/46) required three more bevacizumab injections. At the last follow-up visit, mean visual acuity was stable at 20/100. Vision was stable or improved in 32 of 46 eyes (70%) from the first combination therapy to the final follow-up visit.
Combination bevacizumab and PDT appears to have favorable clinical outcomes in terms of visual acuities and may decrease the number of treatments required in poor responders to bevacizumab monotherapy. Further study would be helpful to determine if this strategy should be recommended in patients requiring ongoing treatment with multiple injections of VEGF inhibitors.
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