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Combination therapy for neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor agents
Journal article   Peer reviewed

Combination therapy for neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor agents

Kevin Tozer, A Brock Roller, Lawrence P Chong, SriniVas Sadda, James C Folk, Vinit B Mahajan, Stephen R Russell, H Culver Boldt and Elliott H Sohn
Ophthalmology (Rochester, Minn.), Vol.120(10), pp.2029-2034
10/2013
DOI: 10.1016/j.ophtha.2013.03.016
PMID: 23714319

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Abstract

To examine the outcomes of combination anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) for the treatment of neovascular age-related macular degeneration (AMD) refractory to anti-VEGF monotherapy. Retrospective, interventional case series. Twenty-six eyes of 26 patients treated with anti-VEGF monotherapy for neovascular AMD with persistent subretinal or intraretinal fluid after at least 3 anti-VEGF injections in the 7 months before combination treatment. Combination anti-VEGF treatment and PDT. Visual acuity at 1 or 2, 3, and 6 months and central retinal thickness at 1 or 2, 3, and 6 months. Secondary outcome measures were change in number of fluid-free visits and interval between treatments in the 7 months before and 6 months after combination therapy. Statistically significant improvements in logarithm of the minimum angle of resolution visual acuities were present at 1 month (P = 0.01) and 3 months (P = 0.01). Significant decreases in central subfield retinal thickness on optic coherence tomography (OCT) were seen at 1 month (P = 4×10(-5)), 3 months (P = 3×10(-4)), and 6 months (P = 4×10(-5)) as compared with precombination treatment OCT scans. The percentage of patient visits with no subretinal fluid increased from 0.5% to 41% after the initiation of combination therapy (P = 1×10(-5)). The interval between treatments increased from once every 1.6 months in the 7 months before combination treatment to once every 2.7 months in the 6 months after combination treatment (P = 0.002). No ocular complications attributable to PDT were seen. Rescue therapy with the combination of anti-VEGF and PDT in eyes that have failed anti-VEGF monotherapy resulted in a mean improvement in vision, a decreased central subfield retinal thickness, and an increase in fluid-free intervals. The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Porphyrins - administration & dosage Antibodies, Monoclonal, Humanized - therapeutic use Macular Degeneration - physiopathology Humans Macular Degeneration - complications Middle Aged Choroidal Neovascularization - therapy Male Vascular Endothelial Growth Factor A - antagonists & inhibitors Photochemotherapy Choroidal Neovascularization - physiopathology Bevacizumab Photosensitizing Agents - administration & dosage Macular Degeneration - therapy Ranibizumab Angiogenesis Inhibitors - therapeutic use Adult Female Aged Combined Modality Therapy - methods Retrospective Studies Choroidal Neovascularization - complications Visual Acuity - physiology

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