Treatment of Choroidal Neovascularization (CNV) Associated With Age Related Macular Degeneration (AMD) With Photodynamic Therapy and Bevacizumab (Avastin) Inyection

Abstract

Purpose:: Evaluate the short term safety and efficacy of combined use of intraocular bevacizumab and photodynamic therapy (PDT) with verteporfin in patients with Age-related macular degeneration (AMD).

Methods:: A prospective, non-randomized case series in which patients with diagnosis of neovascular AMD were treated with PDT using the standard protocol followed by 2.5 mg of intravitreal bevacizumab injection 5 days later. Complete ophthalmologic evaluation was performed in all patients, including best corrected visual acuity (BCVA), slit lamp biomicroscopy, ocular fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT) prior to and 1, 3 and 6 months post treatment.

Results:: 10 eyes of 10 patients were included. The median age was 74 years old (range 65-84), with an average BCVA of 0.6 logMAR (range 0.30-0.80) at presentation. Median retinal thickness was 331.8 µm (range 224-457 µm). By the 6 month the mean BCVA was0.46 logMAR (range 0.10-0.80) and median retinal thickness was 223.4 µm (range 106-303 µm). Statistically significant differences were found in visual acuity and retinal thickness before and after treatment (p= 0.026 and p< 0.01, Wilcoxon rank test). Three patients received a second intravitreal injection of bevacizumab due to reactivation of the choroidal neovascularization 4 weeks after the first injection. No complications were found from the PDT or the intravitreal injection.

Conclusions:: Our results suggest that combined intravitreal bevacizumab with photodynamic therapy is well tolerated and is associated with improved visual acuity, decreased retinal thickness by OCT and lesion leakage.

Clinical Trial:: www.clinicaltrials.gov NCT00347399

Keywords: age-related macular degeneration • choroid: neovascularization • laser