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S. G. Adams, Jr., M. Peden, R. Ratnakaram; Combination PDT and VEGF Inhibitor Therapy for Exudative ARMD. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4542.
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Estimates are that 11% of the US population will eventually be affected by age-related macular degeneration. Treatments for ARMD neovascular membranes had been limited to laser photocoagulation therapy or photodynamic therapy (PDT) with verteporfin. Recently, advances have been made with the advent of intravitreal VEGF inhibitors, bringing into question the roll of PDT. An advantage of PDT is the immediate and permanent sealing of neovascular membranes. However, problems with PDT include inflammation and liberation of VEGF, promoting further leakage or new neovascularization. Theoretically, VEGF inhibitors, Macugen (pegaptanib) and Avastin (bevacizumab), offer a direct method of binding VEGF and reducing inflammation seen in PDT. The purpose of this study is to assess the potential beneficial roll of combination therapy using PDT and VEGF inhibitors.
Chart review of 20 patients (22 eyes) at the Gainesville Florida Veterans Administration Hospital that underwent combination therapy with PDT and anti-VEGF medications (either Macugen, Avastin or both).
Six patients received PDT followed by Avastin, five received PDT followed by Macugen, six received Macugen followed by PDT, three received Avastin followed by PDT. Five of the 10 patients receiving Macugen were subsequently switched to Avastin during the course of their treatment. Preliminary analyses show visual acuity (VA) at baseline ranged from 20/70 to CF. VA at follow-up ranged from 20/25 to CF. Fifty percent of patients showed an improvement in VA (range 1 to 7 lines; mean 2.2). Seventy-five percent of patients receiving PDT first had an improvement in VA (range 1-6 lines, mean 2.1). Thirty-three percent of patients receiving VEGF inhibition first had an improvement in visual acuity (range 1-7 lines, mean 1.33). Five eyes lost vision. Future analyses will compare these patients to an age matched control group of 20 patients each receiving only PDT, Macugen, or Avastin.
The combined use of PDT and VEGF inhibition can be beneficial in terms of visual recovery. Implications for such combination therapy will be discussed.
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