A prospective study on different methods for the treatment of choroidal neovascularization. The efficacy of verteporfin photodynamic therapy, intravitreal bevacizumab and transpupillary thermotherapy in patients with neovascular age-related macular degeneration.
BACKGROUND
The aim of this study was to compare the efficacy of verteporfin photodynamic therapy (PDT), intravitreal injections of bevacizumab (IVB) and transpupillary thermotherapy (TTT) in patients with neovascular age-related macular degeneration (AMD).


METHODS
The study design was a prospective, interventional, comparative case series. Between December 2006 and March 2009, 426 eyes of 426 consecutive patients presenting with neovascular AMD were included into the study. Patients presented with subfoveal CNV predominantly classic, minimally classic, and occult with no classic component; lesion size less than 5000 µm in the greatest linear dimension, and the area of hemorrhages ≤1/3 were randomized to receive either PDT (group I) or IVB (group II) in a 1:1 ratio. Other patients with CNV were included into the group III and received TTT.


RESULTS
One hundred eyes were treated with PDT. Mean baseline logMAR BCVA was 0.62 and final visual acuity decreased to 0.74 (p<0.05, Wilcoxon test); 104 eyes were treated with IVB. Mean baseline BCVA was 0.82 and final visual acuity increased to 0.79 (p>0.05, Wilcoxon test); 222 patients were treated with TTT. Mean baseline BCVA was 1.10 and final visual acuity decreased to 1.15 (p>0.05, Wilcoxon test). Among all eyes the average number of treatment sessions was 2.34 (SD 1.17).


CONCLUSIONS
Our study shows that IVB injections had the best efficacy in the improvement of final BCVA. However, both IVB and TTT demonstrated good stabilization of vision. Although after PDT final BCVA was significantly worse from baseline, it may also be beneficial for some patients with neovascular age-related macular degeneration.
Department of Ophthalmology and Visual Rehabilitation, Medical University of Lodz, Lodz, Poland. michaelnovak@interia.pl
Michał S
MS
Nowak
Piotr
P
Jurowski
Andrzej
A
Grzybowski
Roman
R
Goś
Mirosław
M
Pastuszka
Andrzej
A
Kapica
Janusz
J
Śmigielski
D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003710:Demography; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000494:pharmacology / Q000627:therapeutic use*; D011166:Porphyrins / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D011680:Pupil / Q000187:drug effects; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity / Q000187:drug effects
D061067:Antibodies, Monoclonal, Humanized; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D000068258:Bevacizumab