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Z. B. Ravage, P. T. Merrill, J. M. Civantos; Efficacy of Combined Bevacizumab and Photodynamic Therapy for Neovascular Age-Related Macular Degeneration in Naive Versus Previously Treated Eyes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):556.
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To compare the efficacy of combined bevacizumab and photodynamic therapy in eyes with neovascular age-related macular degeneration (AMD) that had undergone previous photodynamic therapy (PDT) versus those naive to treatment.
We conducted a retrospective chart review of 30 eyes of 29 patients treated with combined bevacizumab and PDT (standard fluence) for predominantly classic choroidal neovascularization (CNV) secondary to neovascular AMD. Patients were treated by a single physician at one office of Illinois Retina Associates between June 2006 and October 2007. Mean patient age was 83 years (74-92). 21 were females, 8 were males.14 eyes had prior treatment with PDT either alone or in combination with intravitreal triamcinolone. 16 eyes were naive to treatment. CNV was diagnosed and classified by fluorescein in angiography (FA). All eyes received initial therapy with PDT followed by bevacizumab on the same day. Patients were re-examined every 6 weeks. Visual acuities (Snellen) were performed on all visits. Optical coherence tomography (OCT) and/or FA were performed if fluid or hemorrhage was detected on exam. Indications for additional treatment included decreased vision, leakage on FA or intra/sub-retinal fluid on OCT. Re-treatment consisted of intravitreal bevacizumab alone or in combination with PDT, at the discretion of the treating physician. Efficacy outcomes included lines of vision gained, final vision and number of re-treatments. Visual acuities were converted to logMAR scale for all calculations.
A total of 59 treatments were administered (41 bevacizumab/PDT, 18 bevacizumab alone). All treatments were well tolerated and without complication. Mean follow-up was 10 months (6-14). Mean initial acuity in both groups was 20/200. Mean final acuity was 20/200 in previously treated eyes and 20/80 in naive eyes, representing a statistically significant difference (p= 0.032). Previously treated eyes required a mean of 1.79 ± 1.37 treatments and naive eyes 2.12 ± 1.54 treatments. In previously treated eyes, 71% lost < 3 lines and 36% gained ≥ 3 lines. In treatment naïve eyes, 94% lost < 3 lines and 38% gained ≥ 3 lines.
Combination treatment with bevacizumab and PDT is effective for the treatment of eyes with predominantly classic CNV secondary to neovascular AMD. Fewer treatments are required compared to standard anti-VEGF monotherapy over a similar period. Treatment naive eyes may show an improved response to therapy and better final visual acuities than those treated with previous PDT.
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