Intravitreal bevacizumab alone versus in combination with photodynamic therapy for the treatment of neovascular maculopathy in patients aged 50 years or older: 1‐year results of a prospective clinical study

Abstract

ABSTRACT.Purpose: To compare the outcomes of treatment with intravitreal bevacizumab alone (BEVA group) or in combination with photodynamic therapy (PDT) (COMB group), in patients aged at least 50 years with neovascular maculopathy. Methods: Forty-one patients with neovascular age-related macular degeneration (AMD) (n = 31) or polypoidal choroidal vasculopathy (PCV) (n = 10) were randomized to either the BEVA group (n = 18) or the COMB group (n = 23). A total of three intravitreal bevacizumab injections (1.25 mg ⁄ 0.05 ml) were given at 6-week intervals. In the COMB group, PDT was included near the time of one injection. Patients underwent best-corrected visual acuity (BCVA) measurement and optical coherence tomography (OCT) at every visit. Fluorescein angiography and indocyanine green angiography were repeated every 3 months. Results: Overall BCVA (p = 0.001) and central foveal thickness (CFT) (p < 0.001) measured by OCT improved significantly at 12 months, and there was no between-group difference in BCVA or CFT between the BEVA and COMB groups. Whereas AMD patients showed significant improvement in BCVA (p = 0.001) and CFT (p = 0.004), PCV patients failed to improve. The effect of bevacizumab alone on neovascular AMD was similar to that of combination therapy, when measured by both BCVA and CFT. The total number of bevacizumab injections was not reduced when PDT was given, either among all patients or in a subgroup of naı¨ve patients (p > 0.05). No serious complication was noted. Conclusion:The results of our 12-month prospective study indicate that intravitreal bevacizumab alone has similar efficacy and safety to bevacizumab plus PDT for treatment of patients with neovascular AMD, even treatment-naı¨ve patients. The addition of PDT did not assist in reducing the required total number of bevacizumab injections.

Polypoidal Choroidal Vasculopathy

“…30 A single clinical trial in neovascular AMD and PCV was graded as level II, but, because only 10 of the randomized patients had PCV, this effectively constitutes level III evidence for this indication. 76 The remaining articles were considered to be level III evidence, together with the collective unpublished experience and expertise of the panel.…”

Polypoidal Choroidal Vasculopathy in Asians

“…There are fewer studies assessing the efficacy of bevacizumab, and most of them have short follow up duration or were not performed on treatment naïve patients [164,165,166,167,168,169,170,171]. In a retrospective case control study, Cho et al .…”

Therapies for Neovascular Age-Related Macular Degeneration: Current Approaches and Pharmacologic Agents in Development

“…Combination of all groups showed a mean gain of VA of 5.7 letters at week 12 and 5.3 letters at week 52 ( P < 0.0001) [20, 22]. Ocular AEs of aflibercept included conjunctival hemorrhage (38.2%, 5.6%), retinal hemorrhage (14.0%, 11.3%), subjective visual loss (13.4%, 6.3%), vitreous detachment (11.5%, 7.3%), and eye pain (9.6%, 11.4%) at the end of the study [20, 23]. …”