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

Jong-Hyun Oh; Seong-Woo Kim; Jaeryung Oh; Soon-Sun Kwon; Kuhl Huh

doi:10.3341/jkos.2013.54.10.1554

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Oh, Kim, Oh, Kwon, and Huh: Bevacizumab Monotherapy Versus Combined Therapy with Photodynamic Therapy for Occult Choroidal Neovascularization in Age-Related Macular Degeneration

Original Article

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

Published online: 3 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.10.1554

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

Jong-Hyun Oh, MD, PhD¹, Seong-Woo Kim, MD, PhD², Jaeryung Oh, MD, PhD², Soon-Sun Kwon, PhD³, Kuhl Huh, MD, PhD²

¹Department of Ophthalmology, Ilsan Hospital, Dongguk University, Goyang, Korea

²Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

³Department of Biostatistics, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Seong-Woo Kim, MD, PhD, Department of Ophthalmology, Korea University Ansan Hospital, #123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea, Tel: 82-31-412-5160, Fax: 82-31-412-4864, E-mail: ksw64723@korea.ac.kr

Received 4 January 2013 Revised 14 May 2013 Accepted 24 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Age-related macular degeneration, Bevacizumab, Occult choroidal neovascularization, Photodynamic therapy

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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.

Table 1.

Baseline characteristics of the patients

	IVB group^* (n = 39)	PDT+IVB group^†(n = 25)	p-value
Eyes	39	25
Mean age (years)	67.79 ± 8.18	71.45 ± 7.73	0.077
No. of males/females	24/15	14/11	0.660
Diabetes (%)	17.9	12.0	0.728^‡
Hypertension (%)	38.5	28.0	0.390
Subfoveal PED (%)	46.2	60.0	0.280
Subfoveal hemorrhage (%)	46.2	36.0	0.422
Greatest diameter of lesion (mm)	3.22 ± 1.65	3.06 ± 1.73	0.716
Mean BCVA (log MAR)	0.85 ± 0.57	0.95 ± 0.52	0.457
Mean CMT (μm)	283.6 ± 101.8	296.6 ± 120.3	0.655

Values are presented as mean ± SD.

PED = pigment epithelial detachment; BCVA = best-corrected visual acuity; CMT = central macular thickness.

^* Patients who underwent intravitreal bevacizumab monotherapy;

^† Patients who underwent combined therapy with half-fluence rate verteporfin photodynamic therapy;

^‡ Fisher's exact test.

Table 2.

Changes in best-corrected visual acuity during the 12-month follow-up period

	n (eyes)	IVB group^*	n (eyes)	PDT+IVB group^†	p-value
Baseline (log MAR)	39	0.85 ± 0.57	25	0.95 ± 0.52	0.457
3 months (log MAR)	38	0.75 ± 0.51	22	0.71 ± 0.54	0.794
6 months (log MAR)	34	0.67 ± 0.47	21	0.73 ± 0.57	0.665
9 months (log MAR)	36	0.75 ± 0.49	17	0.77 ± 0.48	0.870
12 months (log MAR)	39	0.77 ± 0.56	25	0.79 ± 0.60	0.918

^* Patients who underwent intravitreal bevacizumab monotherapy;

^† Patients who underwent combined therapy with half-fluence rate verteporfin photodynamic therapy.

Table 3.

Results after 12 months of follow-up

	IVB group^* (39 eyes)	PDT+IVB group^† (25 eyes)	p-value
Mean difference in BCVA (log MAR) from baseline	−0.07 ± 0.36 (p = 0.213)	−0.16 ± 0.38 (p = 0.046)
Mean difference in CMT (μm) from baseline	−73.1 ± 102.9 (p< 0.001)	−115.4 ± 115.7 (p< 0.001)	0.195
Retreatment (%)	74.4	28.0	< 0.001
Mean number of additional IVB injections	1.59 ± 1.33	0.52 ± 1.01	0.001

Values are presented as mean ± SD.

BCVA = best-corrected visual acuity; CMT = central macular thickness; IVB = intravitreal bevacizumab.

^* Patients who underwent intravitreal bevacizumab monotherapy;

^† Patients who underwent combined therapy with half-fluence rate verteporfin photodynamic therapy.

Table 4.

Changes in central macular thickness during the 12-month follow-up period

	n (eyes)	IVB group^*	n (eyes)	PDT+IVB group^†	p-value
Baseline (μm)	39	283.6 ± 101.8	25	296.6 ± 120.3	0.655
3 months (μm)	38	198.5 ± 66.3	22	204.1 ± 70.0	0.764
6 months (μm)	34	224.4 ± 75.2	21	220.2 ± 110.1	0.888
9 months (μm)	36	208.1 ± 85.9	17	227.0 ± 82.7	0.499
12 months (μm)	39	206.9 ± 89.3	25	181.1 ± 56.8	0.209

Values are presented as mean ± SD.

^* Patients who underwent intravitreal bevacizumab monotherapy;

^† Patients who underwent combined therapy with half-fluence rate verteporfin photodynamic therapy.

Table 5.

Visual changes from baseline during the 12-month follow-up period

	IVB group ^*(39 eyes)				PDT+IVB group^† (25 eyes)
Visual Changes	3 months (n = 38) (%)	6 months (n = 34) (%)	9 months (n = 36) (%)	12 months (n = 39) (%)	3 months (n = 22) (%)	6 months (n = 21) (%)	9 months (n = 17) (%)	12 months (n = 25) (%)
Gain of ≥ 0.3 log MAR	11 (28.9)	10 (29.4)	8 (22.2)	9 (23.1)	8 (36.4)	8 (38.1)	8 (47.1)	9 (23.1)
No change or gain of < 0.3 log MAR	19 (50.0)	15 (44.1)	19 (52.8)	17 (43.6)	10 (45.5)	9 (42.9)	4 (23.5)	17 (43.6)
Loss of < 0.3 log MAR	5 (13.2)	5 (14.7)	7 (19.4)	10 (25.6)	2 (9.1)	2 (9.5)	2 (11.8)	10 (25.6)
Loss of ≥ 0.3 log MAR	3 (7.9)	4 (11.8)	2 (5.6)	3 (7.7)	2 (9.1)	2 (9.5)	3 (17.6)	3 (7.7)

IVB = intravitreal bevacizumab; PDT+IVB = photodynamic therapy+intravitreal bevacizumab.

^* Patients who underwent intravitreal bevacizumab monotherapy;

^† Patients who underwent combined therapy with half-fluence rate verteporfin photodynamic therapy.

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