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G. Lo Giudice, M. Gismondi, V. de Belvis, V. Maritan, G. Prosdocimo; Single-Session Photodynamic Therapy Combined with Intravitreal Bevacizumab for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2158.
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To evaluate the efficacy of combined therapy consisting of single-session photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) for the treatment of retinal angiomatous proliferation (RAP) secondary to age-related macular degeneration.
In a retrospective, nonrandomized, interventional case series, 8 eyes of eight patients with RAP underwent indocyanine green angiography (ICGA) guided a single-session PDT with verteporfin followed by intravitreal bevacizumab (1.25 mg/0.05 ml) within a 7-day interval. All patients were naive to treatment. Complete ocular examination including best corrected visual acuity (BCVA), fluorescein angiography (FA), ICGA, optical coherence tomography (OCT), were performed at baseline and each follow-up visit. All patients received three consecutive monthly intravitreal injections of bevacizumab. Thereafter, retreatment with only bevacizumab was performed if one of the following changes were observed: a loss of five letters in conjunction with fluid in the macula as detected by OCT, an increase in OCT central retinal thickness of at least 100 µm, new-onset of CNV, new macular hemorrhage, or persistent macular fluid detected by both OCT and FA/ICGA at least one month after the previous injection of avastin. Interval data were analyzed statistically at 3, 6 and 9 months follow-up.
This series included eight eyes of eight patients with mean age 67.6 ± 7.2 years. All patients had 9 months of follow-up. Mean BCVA prior to treatment was 0.21 ± 0.09 logMAR which improved to 0.41 ± 0.20 logMAR (P = 0.05), 0.40± 0.15 logMAR, and 0.42 ± 0.14 logMAR (P = 0.005) after 12 weeks, 6 and 9 months respectively. Mean pretreatment central macular thickness (CMT) was 371.9 ± 194.3µm which was significantly reduced to 140 ± 59.3µm , 162.8 ± 77.8µm (P = 0.028) and 162 ± 74.1µm 3, 6 and 9 months after initial treatment respectively (P <0.0001). Two patients developed recurrent leakage after three to six months, which settled completely after repeat IVB.
Sequenced combined treatment with single-session PDT and IVB may be useful in treating RAP, reducing or eliminating retinal edema, and improving visual acuity. Further investigations are warranted to outline the appropriate treatment paradigm for combination therapy.
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