Purpose:

To evaluate the effect of anti-vascular endothelial growth factor (VEGF) alone or in combination with photodynamic therapy (PDT) on visual acuity (VA) in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Material and Method:

The records of 28 eyes of 28 patients with CNV secondary to AMD treated between January 2007 and November 2009 were reviewed retrospectively. VA measured with ETDRS chart, intraocular pressure, slit-lamp examination, fundus examination, optical coherence tomography (OCT), and fluorescein angiography findings were evaluated before the treatment procedure. Group 1 included eyes treated with intravitreal injections of ranibizumab and Group 2 included eyes treated with combination of PDT and ranibizumab. Anti-VEGF treatment protocol was 3 monthly injections followed by monthly monitoring, and additional injection was performed according to VA and OCT findings. In the combination group, PDT was followed by anti-VEGF injection 48-72 hours later; reinjection was done according to VA and OCT findings.

Results:

The mean age of patients was 70.7±6.9 (range: 53-85) years and the mean follow-up time was 10.1±5.9 (range: 6-20) months. Group 1 included 18 eyes and group 2-10 eyes. The average number of injections was 3.38 and 1.5, respectively. The mean VA before treatment was 43 letters in group 1 and 41 letters in group 2. The mean VA after treatment was 54 and 40 letters, respectively. There was no difference between the two groups in terms of VA before and after treatment. A gain of 15 letters or more from baseline was seen in 5 eyes in group 1 and in 3 eyes in group 2. Two eyes in group 1 and 2 eyes in group 2 had lost 15 letters or more from baseline.

Discussion:

It was observed that in the treatment of CNV secondary to AMD, anti-VEGF agents were effective in terms of improvement and stabilization of VA; however, combination therapy had no additional effect on VA.

Keywords: Age related macular degeneration, choroidal neovascular membrane, photodynamic therapy, ranibizumab