title: Combination therapy for neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor agents.
abstract: OBJECTIVE
  To examine the outcomes of combination anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) for the treatment of neovascular age-related macular degeneration (AMD) refractory to anti-VEGF monotherapy.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  Twenty-six eyes of 26 patients treated with anti-VEGF monotherapy for neovascular AMD with persistent subretinal or intraretinal fluid after at least 3 anti-VEGF injections in the 7 months before combination treatment.
  
  
  METHODS
  Combination anti-VEGF treatment and PDT.
  
  
  METHODS
  Visual acuity at 1 or 2, 3, and 6 months and central retinal thickness at 1 or 2, 3, and 6 months. Secondary outcome measures were change in number of fluid-free visits and interval between treatments in the 7 months before and 6 months after combination therapy.
  
  
  RESULTS
  Statistically significant improvements in logarithm of the minimum angle of resolution visual acuities were present at 1 month (P = 0.01) and 3 months (P = 0.01). Significant decreases in central subfield retinal thickness on optic coherence tomography (OCT) were seen at 1 month (P = 4×10(-5)), 3 months (P = 3×10(-4)), and 6 months (P = 4×10(-5)) as compared with precombination treatment OCT scans. The percentage of patient visits with no subretinal fluid increased from 0.5% to 41% after the initiation of combination therapy (P = 1×10(-5)). The interval between treatments increased from once every 1.6 months in the 7 months before combination treatment to once every 2.7 months in the 6 months after combination treatment (P = 0.002). No ocular complications attributable to PDT were seen.
  
  
  CONCLUSIONS
  Rescue therapy with the combination of anti-VEGF and PDT in eyes that have failed anti-VEGF monotherapy resulted in a mean improvement in vision, a decreased central subfield retinal thickness, and an increase in fluid-free intervals.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Doheny Eye Institute and the Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; VMR Institute, Huntington Beach, California.
authors.forename: Kevin
authors.initials: K
authors.lastname: Tozer
authors.forename: A Brock
authors.initials: AB
authors.lastname: Roller
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Chong
authors.forename: SriniVas
authors.initials: S
authors.lastname: Sadda
authors.forename: James C
authors.initials: JC
authors.lastname: Folk
authors.forename: Vinit B
authors.initials: VB
authors.lastname: Mahajan
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Russell
authors.forename: H Culver
authors.initials: HC
authors.lastname: Boldt
authors.forename: Elliott H
authors.initials: EH
authors.lastname: Sohn
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000008:administration & dosage; D011166:Porphyrins / Q000008:administration & dosage; D000069579:Ranibizumab; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D017319:Photosensitizing Agents; D011166:Porphyrins; D042461:Vascular Endothelial Growth Factor A; D000077362:Verteporfin; D000068258:Bevacizumab; D000069579:Ranibizumab