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C. Mapelli, F. Viola, E. Villani, F. Tresca Carducci, L. Tresoldi, G. Ceresara, L. Sinigaglia, R. Ratiglia; Sequenced Combined Intravitreal Bevacizumab and Photodynamic Therapy for Retinal Angiomatous Proliferation. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5618.
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To study visual and anatomical outcomes after sequenced combined therapy using intravitreal bevacizumab (Avastin) followed by photodynamic therapy (PDT) in eyes with retinal angiomatous proliferation (RAP). Safety and number of required intravitreal re-injections were also evaluated.
We conducted a prospective non-comparative consecutive study of patients newly diagnosed as having RAP in ARMD. Patients underwent intravitreal bevacizumab injection to reduce intraretinal and subretinal exudation, followed 8 ± 2 days later by indocyanine green angiography-guided PDT.At baseline and 1, 3, 6 and 9 months after the injection, best-corrected visual acuity measurement (BCVA), complete eye examination including dynamic fluorescein and ICG angiography and optical coherence tomography (OCT) were performed.BCVA was evaluated and expressed with logMAR method using ETDRS charts at 4 and 1 meter distance.A repeated IVT treatment was performed if there was angiographic evidence of persistent or increased lesion activity or increased lesion size compared to baseline angiograms.
Twenty-one eyes of 18 patients with RAP were enrolled. The mean age was 77.42± 6.78. Mean visual acuity at baseline was 0.63 ± 0.25 logMAR. After treatment VA was 0.57± 0.25, 0.60 ± 0.32, 0.69 ± 0.36 and 0.84 ± 0.48 logMAR at 1, 3, 6 and 9 months respectively, with no statistically significant differences between each visits (P=0.10, ANOVA).At the end of follow-up, lesions angiographically improved in 9 eyes (43%), remained stable in 3 eyes (14%) and progressed in 9 eyes (43%).Foveal thickness decreased significantly between baseline and all the follow-up visits (P< 0.01 ANOVA). Max thickness decreased significantly between baseline and month 1 visits (P< 0.01 LSD post hoc test), but increased significantly between month 1 and month 6 visits (P< 0.05 LSD post hoc test).A total of 36 intravitreal injections were given during the study with a mean of 1.7 injections per eye (range 1-3 injections per eye). Nine patients required 2 injections and 3 patients required 3 injections.No ocular or systemic adverse events were reported.
This sequenced combined treatment resulted in significant decrease in foveal thickness and stabilization of visual acuity.
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