title: Verteporfin photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To assess outcomes for patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) treated with verteporfin photodynamic therapy (PDT) and bevacizumab.
  
  
  METHODS
  Retrospective, case series database study (registry).
  
  
  METHODS
  We included 1196 patients with CNV due to AMD who received > or =1 combination treatment of 1.25 mg intravitreal bevacizumab within 14 days of verteporfin PDT.
  
  
  METHODS
  Retrospective analysis of baseline data with ongoing follow-up. Physicians from 45 clinical centers entered patient data at baseline and follow-up examinations, including subsequent treatments, into a secure, Web-accessed database. Snellen visual acuity (VA) was converted to logarithm of the minimum angle of resolution (logMAR) for statistical analyses.
  
  
  METHODS
  Change from baseline in VA and retreatment rates of any therapy after the initial combination treatment.
  
  
  RESULTS
  Of 1196 patients, 1073 patients had > or =6 months of follow-up. For these 1073 patients, mean baseline VA was 0.967 logMAR (approximate Snellen 20/185) and 56.3% of patients (604/1073) were treatment naïve. After their baseline combination treatment, patients received a mean of 0.6 additional verteporfin PDT retreatments and 2.0 bevacizumab retreatments over a mean follow-up period of 15.0 months. By 12 months, 82% of patients (578/701) had stable or improved vision (loss of <3 lines or a gain in VA), 36% (255/701) improved by > or =3 lines, and 17% (121/701) improved by > or =6 lines. By 12 months, patients gained approximately 1.2 lines (6 letters) of VA from baseline. Patients who were treatment naïve gained significantly more VA by month 12 (+8.4 letters) compared with those who had been previously treated (+2.4 letters; P<0.01). Most serious adverse events (26/30) were judged by investigators as not related to any study treatment, although 3 ocular events were judged related to bevacizumab alone, and 1 ocular event was judged related to both bevacizumab and PDT.
  
  
  CONCLUSIONS
  Combination therapy with PDT and bevacizumab led to vision benefit for most patients, particularly those who were treatment naïve at baseline. The number of retreatments was lower than published reports with either treatment delivered as monotherapy. Randomized clinical trials are underway to confirm these findings.
authors.affiliation: Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. pkkaiser@aol.com
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.forename: David S
authors.initials: DS
authors.lastname: Boyer
authors.forename: Raul
authors.initials: R
authors.lastname: Garcia
authors.forename: Yong
authors.initials: Y
authors.lastname: Hao
authors.forename: Mark S
authors.initials: MS
authors.lastname: Hughes
authors.forename: N M
authors.initials: NM
authors.lastname: Jabbour
authors.forename: Peter K
authors.initials: PK
authors.lastname: Kaiser
authors.forename: William
authors.initials: W
authors.lastname: Mieler
authors.forename: Jason S
authors.initials: JS
authors.lastname: Slakter
authors.forename: Michael
authors.initials: M
authors.lastname: Samuel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tolentino
authors.forename: Daniel
authors.initials: D
authors.lastname: Roth
authors.forename: Thomas
authors.initials: T
authors.lastname: Sheidow
authors.forename: H Andrew
authors.initials: HA
authors.lastname: Strong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D017319:Photosensitizing Agents; D011166:Porphyrins; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; D000068258:Bevacizumab