J Korean Ophthalmol Soc.  2013 Oct;54(10):1554-1560.

Bevacizumab Monotherapy Versus Combined Therapy with Photodynamic Therapy for Occult Choroidal Neovascularization in Age-Related Macular Degeneration

• Oh JH
• Kim SW
• Oh J
• Kwon SS
• Huh K

Abstract

PURPOSE
To compare clinical outcomes between intravitreal bevacizumab (IVB) monotherapy and combined therapy with half-fluence rate verteporfin photodynamic therapy (PDT) for occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
METHODS
Medical records were reviewed in consecutive patients who underwent IVB monotherapy or combined therapy with PDT for occult CNV secondary to AMD and had a 12-month follow-up period. After 3 consecutive monthly IVB injections, both groups were eligible for additional IVB injections when necessary. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and number of additional IVB injections were compared between the groups.
RESULTS
Thirty-nine eyes underwent IVB monotherapy (IVB group) and 25 eyes underwent combined therapy (PDT+IVB group). Mean BCVA improved significantly in the PDT+IVB group (p = 0.046) and not in IVB group (p = 0.213). A significant reduction in mean CMT occurred in both groups (p < 0.001). The mean number of additional IVB injections was 1.6 +/- 1.33 in the IVB group and 0.5 +/- 1.01 in the PDT+IVB group (p = 0.001). There were no serious complications.
CONCLUSIONS
Combined therapy with half-fluence rate PDT improved BCVA and reduced the number of additional IVB injections in the eyes with occult CNV secondary to AMD.

Keyword

Age-related macular degeneration; Bevacizumab; Occult choroidal neovascularization; Photodynamic therapy

MeSH Terms

Antibodies, Monoclonal, Humanized
Choroid*
Choroidal Neovascularization*
Eye
Follow-Up Studies
Humans
Macular Degeneration*
Medical Records
Photochemotherapy*
Porphyrins
Triazenes
Visual Acuity
Bevacizumab
Antibodies, Monoclonal, Humanized
Porphyrins
Triazenes

Figure

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  Figure 1. Changes in best-corrected visual acuity (BCVA) during the 12-month follow-up period. Patients underwent in- travitreal bevacizumab monotherapy (IVB group) or combined therapy with half-fluence rate verteporfin photodynamic therapy (PDT + IVB group) for occult choroidal neovascularization in age-related macular degeneration. Error bars represent + 1 standard error of the mean.

• 

  Figure 2. Changes in central macular thickness during the 12-month follow-up period. Patients underwent intravitreal bevacizumab monotherapy (IVB group) or combined therapy with half-fluence rate verteporfin photodynamic therapy (PDT+IVB group) for occult choroidal neovascularization in age-related macular degeneration. Error bars represent +1 standard error of the mean.

Reference

References

1. Verteporfin Roundtable Participants. Guidelines for using verte- porfin (Visudyne) in photodynamic therapy for choroidal neovascularization due to age-related macular degeneration and other causes: update. Retina. 2005; 25:119–34.

2. Rosenfeld PJ, Brown DM, Heier JS. . Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1419–31.

3. Spaide RF, Laud K, Fine HF. . Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 2006; 26:383–90.

4. Brown DM, Kaiser PK, Michels M. . Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006; 355:1432–44.

5. Regillo CD, Brown DM, Abraham P. . Randomized, double-masked, sham-controlled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol. 2008; 145:239–48.

6. Sonmez K, Sonmez PA, Ozkan SS, Atmaca LS. One-year outcomes of less frequent bevacizumab in age-related macular degeneration. Retina. 2011; 31:645–53.

7. Fung AE, Lalwani GA, Rosenfeld PJ. . An optical coherence tomography-guided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol. 2007; 143:566–83.

8. Cohen SY, Dubois L, Tadayoni R. . Results of one-year's treatment with ranibizumab for exudative age-related macular degeneration in a clinical setting. Am J Ophthalmol. 2009; 148:409–13.

9. Lalwani GA, Rosenfeld PJ, Fung AE. . A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol. 2009; 148:43–58.e1.

10. Lew YJ, Park HJ, Lee TG. . Primary combined photodynamic therapy and intravitreal bevacizumab injection for neovascular age-related macular degeneration. J Korean Ophthalmol Soc. 2010; 51:35–41.

11. Rudnisky C, Liu C, Ng M. . Intravitreal bevacizumab alone versus combined verteporfin photodynamic therapy and intra- vitreal bevacizumab for choroidal neovascularization in age-related macular degeneration: visual acuity after 1 year of follow-up. Retina. 2010; 30:548–54.

12. Bashshur ZF, Schakal AR, El-Mollayess GM. . Ranibizumab monotherapy versus single-session verteporfin photodynamic therapy combined with as-needed ranibizumab treatment for the management of neovascular age-related macular degeneration. Retina. 2011; 31:636–44.

13. Larsen M, Schmidt-Erfùrth U, Lanzetta P. . Verteporfin plus ra- nibizumab for choroidal neovascularization in age-related macular degeneration: twelve-month MONT BLANC study results. Ophthalmology. 2012; 119:992–1000.

14. Kaiser PK, Boyer DS, Cruess AF. . Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration: twelve-month results of the DENALI study. Ophthalmology. 2012; 119:1001–10.

15. Krebs I, Vécsei Marlovits V, Bodenstorfer J. . Comparison of Ranibizumab monotherapy versus combination of Ranibizumab with photodynamic therapy with neovascular age-related macular degeneration. Acta Ophthalmol. 2013; 91:e178–83.

16. Cohen SY, Creuzot-Garcher C, Darmon J. . Types of choroidal neovascularisation in newly diagnosed exudative age-related macular degeneration. Br J Ophthalmol. 2007; 91:1173–6.

17. Verteporfin In Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neo- vascularization–verteporfin in photodynamic therapy report 2. Am J Ophthalmol. 2001; 131:541–60.

18. Soubrane G, Harding SP, Wolf S, Weichselberger A. Verteporfin therapy in occult with no classic CNV due to AMD: results of the Photodynamic Therapy in Occult-Only Lesions study. Eye (Lond). 2009; 23:791–800.

19. Costagliola C, Romano M, Corte MD. . Intravitreal bevacizumab for treatment-naive patients with subfoveal occult choroidal neovascularization secondary to age-related macular degeneration: a 12-month follow-up study. Retina. 2009; 29:1227–34.

20. Furino C, Boscia F, Recchimurzo N. . Intravitreal bevacizumab for treatment-naïve subfoveal occult choroidal neovascularization in age-related macular degeneration. Acta Ophthalmol. 2009; 87:404–7.

21. Japanese Age-Related Macular Degeneration Tial (JAT) Study Group. Japanese age-related macular degeneration trial: 1-year results of photodynamic therapy with verteporfin in Japanese patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. Am J Ophthalmol. 2003; 136:1049–61.

22. Costagliola C, Romano MR, Rinaldi M. . Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration. Br J Ophthalmol. 2010; 94:180–4.

23. Sacu S, Varga A, Michels S. . Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study. Br J Ophthalmol. 2008; 92:1347–51.

24. Spaide R. Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol. 2007; 143:679–80.

25. Ciulla TA, Rosenfeld PJ. Antivascular endothelial growth factor therapy for neovascular age-related macular degeneration. Curr Opin Ophthalmol. 2009; 20:158–65.

26. Miller JW, Schmidt-Erforth U, Sickenberg M. . Photodynamic therapy with verteporfin for choroidal neovascularization caused by age-related macular degeneration: results of a single treatment in a phase 1 and 2 study. Arch Ophthalmol. 1999; 117:1161–73.

27. Kiss CG, Simader C, Michels S, Schmidt-Erfurth U. Combination of verteporfin photodynamic therapy and ranibizumab: effects on retinal anatomy, choroidal perfusion and visual function in the protect study. Br J Ophthalmol. 2008; 92:1620–7.

28. Antoszyk AN, Tuomi L, Chung CY, Singh A. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results. Am J Ophthalmol. 2008; 145:862–74.

29. Parodi MB, Da Pozzo S, Ravalico G. Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopia. Acta Ophthalmol Scand. 2007; 85:50–4.

30. Rouvas AA, Papakostas TD, Ladas ID, Vergados I. Enlargement of the hypofluorescent post photodynamic therapy treatment spot after a combination of photodynamic therapy with an intravitreal injection of bevacizumab for retinal angiomatous proliferation. Graefes Arch Clin Exp Ophthalmol. 2008; 246:315–8.

31. Michels S, Hansmann F, Geitzenauer W, Schmidt-Erforth U. Influence of treatment parameters on selectivity of verteporfin therapy. Invest Ophthalmol Vis Sci. 2006; 47:371–6.

32. Moon SW, Kim MS, Kim ES. . Photodynamic therapy combined with intravitreal injection of vascular endothelial growth factor antibody for polypoidal choroidal vasculopathy. Ophthalmologica. 2011; 225:169–75.

33. Lee JK, Lee JW, Lee JE. . Intravitreal Bevacizumab with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. J Korean Ophthalmol Soc. 2010; 51:684–92.