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D. P. Han, J. T. McAllister, J. E. Kim, D. V. Weinberg, W. J. Wirostko; Combined Intravitreal Anti-VEGF and Verteporfin Photodynamic Therapy for Nonfoveal Choroidal Neovascularization: A Possible Alternative to Macular Photocoagulation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2672.
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Macular laser photocoagulation therapy is an accepted treatment for selected juxtafoveal and extrafoveal choroidal neovascular membranes (CNV) due to age-related macular degeneration (ARMD) and ocular histoplasmosis syndrome (OHS). It has also been used in degenerative myopia with extrafoveal CNV. The potential role of anti-VEGF and photodynamic therapy (PDT) as an alternative to laser treatment in such cases was evaluated.
An IRB-approved, retrospective chart review was performed of 9 eyes of 9 consecutive patients with juxtafoveal or extrafoveal CNV that underwent treatment with intravitreal anti-VEGF agents combined with verteporfin full-fluence PDT (689 nm). Four eyes had ARMD, 3 had OHS, and 2 had degenerative myopia. The five non-ARMD eyes were treated by combined intravitreal bevacizumab 1.25 mg given at intervals of 4-6 weeks and PDT given at intervals of 10-12 weeks, initiated concurrently. Three ARMD eyes underwent an initial regimen of PDT, followed by anti-VEGF treatment started between 2 months and 2 years later. One ARMD eye was treated with concurrent intravitreal ranibizumab therapy and PDT. Retreatment criteria were persistent edema or subretinal fluid on optical coherence tomography (OCT) and/or leakage on fluorescein angiography (FA).
Presenting best corrected visual acuity (VA) ranged from 20/20 to 20/60 (mean log MAR±S.D., 0.330±0.171 [20/43 Snellen equivalent]). After a mean follow-up of 16.1 months, final VA ranged from 20/15 to 20/50 (mean log MAR±S.D., 0.169±0.176 [20/30 Snellen equivalent]; p<0.05, t-test on mean VA improvement). Of the nine eyes, 3 improved by ≥3 lines, 1 improved by 2 lines, and 5 remained within 1 line of initial VA. Non-ARMD eyes with combined bevacizumab/PDT required means of 2.6 injections (range 1-7) and 1.4 PDT sessions (range 1-2). ARMD eyes required means of 5 injections (range 1-9) and 2 PDT sessions (range 1-4). At final follow-up, 4 of the 5 non-ARMD eyes and 1 of 4 ARMD eyes showed no edema/leakage on OCT/FA at a minimum of 5 months after last treatment.
Intravitreal anti-VEGF therapy combined with verteporfin photodynamic therapy was associated with preservation of good visual function, suggesting it may provide a viable alternative to laser in some cases of nonfoveal CNV due to ARMD, OHS, and degenerative myopia. ARMD eyes required longer courses of treatment than non-ARMD eyes.
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