Combined intravitreal bevacizumab and photodynamic therapy with vertiporfin for management of choroidal neovascularization secondary to age-related macular degeneration

Mamdouh M Kabeel¹, Ashraf M El-Batarny², Mohamed K Tameesh³, Moustafa A Abou El Enein¹

¹Tanta University, Egypt, currently affiliated to Magrabi Eye and Ear Hospital, KSA, Vitreoretinal Service; ²Tanta University, Egypt, currently affiliated to Magrabi Eye and Ear Hospital, Muscat, Oman, Vitreoretinal Service; ³Tanta University, Egypt, currently affiliated to Saad Specialist Hospital, KSA, Vitreoretinal Service

Purpose: To test the results for patients treated with combined photodynamic therapy (PDT) with vertiporfin (Visudyne, Novartis AG) and intravitreal bevacizumab for choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Patients and methods: This is a prospective study including 18 eyes with subfoveal or juxtafoveal CNV secondary to AMD. Patients were treated with intravitreal bevacizumab 2.5 mg in the morning then PDT with vertiporfin in the evening of the same day. All patients were followed up for 6 months. The main outcome measures were stabilization (no change) or improvement of best corrected visual acuity (BCVA) with no leakage in fluorescein angiography (FLA) and reduction of central retinal thickness, and retreatment rate.

Results: At the end of 6 months follow up, all cases had either stabilization or improved BCVA. Fifteen eyes (80%) showed improved BCVA. The overall mean improvement in BCVA (n = 18) was 2.17 lines. Fifteen eyes (80%) required single combined treatment. Only 3 eyes (20%) required retreatment with the same protocol. No systemic or ocular complications were reported.

Conclusion: Combined intravitreal bevacizumab and PDT as a treatment of CNV secondary to AMD either for predominantly classic or occult subtypes has a positive therapeutic effect with stabilization or improvement of final BCVA and also might reduce the need for retreatment compared with literature retreatment rates of either modality alone.

Summary: Eighteen patients receiving combined therapy with PDT and intravitreal bevacizumab for CNV secondary to AMD, showed not only significant visual improvement but also reduction in the frequency of retreatment when compared to the results of monotherapy with each modality.

Keywords: intravitreal bevacizumab, photodynamic therapy, vertiporfin, choroidal neovascularization, age-related macular degeneration