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Priyatham S Mettu, Michael J Allingham, Peter Nicholas, Scott W Cousins; Adjunctive Indocyanine Green Angiography-Directed Verteporfin Photodynamic Therapy for the Treatment of Persistent Disease Activity in Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1931.
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© ARVO (1962-2015); The Authors (2016-present)
Assess the efficacy of adjunctive indocyanine green angiography (ICGA)-directed verteporfin photodynamic therapy (PDT) for the treatment of persistent disease activtity (PDA) in spite of anti-vascular endothelial growth factor (VEGF) therapy in patients with neovascular age-related macular degeneration (NV AMD).
Prospective, open-label investigator-initiated study of adjunctive ICGA-directed verteporfin PDT, plus aflibercept, for treatment of PDA in spite of anti-VEGF therapy (n=16). Inclusion criteria included single eye of an individual with (1) active disease in spite of monthly anti-VEGF therapy, either after loading dose (initial three monthly treatments) or after a sustained period of treatment; and (2) identifiable neovascular subtype by ICGA. Eyes were excluded for prior history of PDT or for retinal pigment epitheilum (RPE) atrophy at the focus of treatment. Enrolled eyes underwent treatment according to the specified schedule (Fig. 1), and a repeat PDT treatment was permitted at month 3 for eyes with continued PDA. The study group was stratified by ICGA subtype identified at baseline. Response to adjunctive PDT was assessed by clinical exam, optical coherence tomography (OCT), and fluorescein angiography (FA) and was classified as either "PDA" (unresolved OCT fluid, FA leakage, FA lesion growth, hemorrhage, or progressive fibrosis), or quiescent, using a categorical disease activity scale (Fig. 2).
Patients with PDA undergoing ICGA-directed PDT were comprised of ICGA subtypes of branching arteriolarized vascular complex (BAVC) (56.2%), polypoidal choroidal vasculopathy (PCV) (18.8%), and choroidal leak syndrome (25%). Treatment success of adjunctive PDT, defined as NV AMD disease quiescence or mild (i.e. trivial) disease activity at 6 months, was achieved in 68.8% of eyes. Additionally, ICGA-directed PDT permitted successful extension of aflibercept treatment interval, with sustained disease quiescence, to every 8 weeks in 31.2% of eyes, and to every 6 weeks in 18.8% of eyes in a population that previously had PDA in spite of monthly anti-VEGF therapy.
ICGA-directed verteporfin PDT is effective for the treatment of PDA in spite of anti-VEGF monotherapy and should be considered as an adjunctive treatment option for affected NV AMD patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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