Photodynamic therapy combined with intravitreal bevacizumab for the management of choroidal neovascularization resistant to bevacizumab monotherapy. A case series Terapia fotodinámica combinada con bevacizumab intravítreo para el tratamiento de la neovascularización coroidea refractaria al tratamiento con monoterapia con bevacizumab. Una serie de casos Academic Article in Scopus uri icon

abstract

  • © 2019 Publicaciones Permanyer. All rights reserved.Purpose: To evaluate the clinical response of treatment-resistant choroidal neovascularization (CNV) to photodynamic therapy (PDT) combined with bevacizumab (BVZ) therapy. Methods: Retrospective, non-comparative evaluation of eyes diagnosed with CNV secondary to age-related macular degeneration that had no response after at least 3 intravitreal BVZ injections, who were treated with combined PDT+BVZ therapy, followed by subsequent monthly BVZ for a 6-month period. Main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a 6 month follow-up period after combined therapy. Results: Eleven patients (54.5% female, mean age 62 years) were included. Using ICG angiography, lesions were classified as polypoidal choroidal vasculopathy (PCV) in 54.5%, arteriolized CNV in 18.2% (2), and non-differentiable in 27.3% (3). BCVA (logMAR) at baseline was 0.63 (20/85), increasing to 0.32 (20/40) 6 months after treatment (p = 0.04). Mean CMT before the intervention was 469 ¿m, decreasing to 289 ¿m 6 months after treatment (p = 0.01). Conclusion: Combined PDT+BVZ therapy appears to be effective in treatment-resistant CNV, with an improvement of BCVA and CMT after a 6-month period that was not observed with BVZ monotherapy. A high incidence of PCV and arteriolized CNV or treatment-resistant CNV cases was observed in this group. The correct classification of highly resistant CNV types may be useful for treatment.

publication date

  • January 1, 2019