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S. Mennel, C. H. Meyer, J. Callizo, J. C. Schmidt; Immediate Oct Following Combined Intravitreal Anti-Vegf and Photodynamic Therapy to Treat Exudative Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3392.
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Photodynamic therapy (PDT) is a well established clinical treatment for age-related macular degeneration (AMD). The combination with intravitreal anti-VEGF (vascular endothelial growth factor) has shown beneficial therapeutic effects. PDT causes transient subretinal fluid accumulation. Optical coherence tomography (OCT) was used to evaluate early structural alterations following the combined treatment strategy.
Anti-VEGF has been injected intravitreally either before (n=5) or after PDT (n=5). Optical coherence tomography (OCT) was performed before the combined PDT and anti-VEGF treatment and at 2 as well as 7 days later.
Our results demonstrate an immediate serous retinal detachment due to fluid accumulation at the treated area if anti-VEGF was performed after PDT. If anti-VEGF was applicated at least 5 days prior to PDT not fluid accumulation was noted within seven days.
If anti-VEGF is injected more than 2 days after PDT the subretinal fluid accumulation, which is typical at 2 days after PDT monotherapy, cannot affected. Only if anti-VEGF is applicated prior to PDT the transient subretinal fluid accumulation can be inhibited. As PDT causes a breakdown of the outer blood-retinal barrier (BRB) function and therefore leads to subretinal fluid accumulation, anti-VEGF seems to be beneficial as an additional treatment strategy to stabilize the outer BRB and reduce intra- and subretinal fluid. To counteract PDT induced subretinal fluid accumulation anti-VEGF should be administered prior to PDT.
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