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S. A. Pilyugina, W. R. Freeman, N. Nigam, M. Goldbaum; Visudyne Photodynamic Therapy for ARMD-Associated CNV After Initial Treatment Course With Bevacizumab. Invest. Ophthalmol. Vis. Sci. 2008;49(13):559.
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To evaluate the efficacy and safety of verteporfin photodynamic therapy (PDT) given after serial intravitreal Bevacizumab for choroidal neovascularization (CNV) due to age-related macular degeneration (AMD). We hypothesized that PDT may stabilize the treated CNV preventing or reducing the recurrence rate.
In this retrospective consecutive series, 20 eyes of 20 patients were included. Treatment-naïve males or females, aged ≥ 50 years, with classic, minimally classic, or occult AMD-induced CNV were evaluated. Visual acuity (VA), complete ocular examination and optical coherence tomography (OCT) were recorded. PDT was administered on average within 42 days of complete healing of CNV (dry on OCT) from a course of monthly Bevacizumab. The main outcome measures included time to reactivation after primary healing with Bevacizumab and change in VA.
Median follow up was 13 months (6-20). All eyes received an average of 4 (2-6) Bevacizumab injections prior to PDT. Reactivation of CNV occurred in 50% of eyes at a mean time of 3 months after the PDT. This recurrence rate was nearly identical to that of a matched series of 20 eyes who received Bevacizumab monotherapy and who were observed off treatment after healing. In the eyes with CNV reactivation there was a decrease in VA by 2 lines associated with increase in OCT fluid. In the remaining 10 eyes, visual acuity did not change before vs. after the PDT treatment.
PDT does not appear to reduce the recurrence rate for patients in our cohort of eyes with CNV treated initially with Bevacizumab compared to eyes with cessation of Bevacizumab without PDT. CNV recurrence rate was 50%. In eyes without recurrence, a single course of PDT after reabsorption of CNV-related retinal fluid caused no adverse effect on VA. A larger and long-term prospective randomized trial is needed to confirm these results.
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