Anti-VEGF therapy improves vision less following PDT The vision of patients with persistent or reactivated choroidal neovascularization (CNV) that had been previously treated with photodynamic therapy (PDT) improve less than treatment-naive patients.

Baseline assessments including best-corrected visual acuity, fluorescein angiography (FFA), and optical coherent tomography (OCT) were performed. Intravitreal Lucentis (ranibizumab) and/or Avastin (bevacizumab) were administered on an as-needed basis, guided by changes in visual outcome and OCT findings. The follow-up period was at least 6 months.

Twenty-five subjects with predominantly classic CNV, previously treated with PDT (mean 1.84 PDT sessions) showed reactivation or persistent CNV. The mean interval between PDT and intravitreal anti-VEGF treatment was 18.32 months (1–48 months); and patients received an average of 3.2 injections over a 6-month period. The mean change of visual acuity following PDT was -10.12 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (54.3615.79–44.2417.32 letters). Following anti-VEGF therapy, the mean change in visual acuity at 3 and 6 months were +1.76 and +0.72, respectively. The proportion of subjects with stable vision (loss of 15 letters) was 96% at 3 months and 88% at 6 months; the proportion of subjects who showed improved vision (15 letters) was 8% at 3 months and 4% at 6 months.

Anti-VEGF agents stabilised the visual outcomes of eyes previously treated with PDT. However, the proportion of patients who showed improved vision in this group was smaller than the proportion reported in subjects with treatment-naive lesions.

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Eye (Lond). 2009 Nov 6. [Epub ahead of print]