Anti-vascular endothelial growth factor monotherapy versus combination treatment with photodynamic therapy for subfoveal choroidal neovascularization secondary to causes other than age-related macular degeneration

Abstract

Purpose: To compare the visual outcomes and retreatment rates of monotherapy with intravitreal bevacizumab versus combination with photodynamic therapy for choroidal neovascularization secondary to causes other than age-related macular degeneration.

Methods: Seventeen patients received intravitreal bevacizumab, and 6 patients underwent intravitreal bevacizumab combined with verteporfin photodynamic therapy within 3 days. Additional bevacizumab was administrated if there was persistent fluorescein leakage or subretinal fluid on optical coherence tomography.

Results: The mean change in visual acuity was vision gain of 1.7 lines in the monotherapy group compared with 2.8 lines in the combination therapy group at 12-month follow-up (P = 0.45). At 12 months, 93% in the monotherapy group and 100% in the combination group lost <2 lines of vision (P = 1.0); 36% gained >3 lines of vision in the monotherapy compared with 60% in the combination therapy group (P = 0.60). The monotherapy group received a mean of 4.8 reinjections, while the combination group received 2.6 reinjections over 12 months (P = 0.11). Subgroup analysis of cases of choroidal neovascularization caused by pathologic myopia demonstrated a mean change in visual acuity of vision gain of +2.0 lines in the monotherapy group versus +2.3 lines in the combination therapy group (P = 0.82) and a mean of 7.2 reinjections versus 2 in monotherapy and combination group, respectively (P = 0.0498) at 12 months.

Conclusion: The majority of patients had stabilization or improvement in vision in both treatment groups. Combination therapy with bevacizumab plus photodynamic therapy showed lower retreatment rates in patients with myopia. Randomized clinical trials are necessary to confirm these findings.