Anti-VEGF therapy for choroidal neovascularisation previously treated with photodynamic therapy

Purpose This interventional, noncomparative case series assessed the outcome of intravitreal pan-anti-vascular endothelial growth factor (VEGF) agents in eyes with persistent or reactivated choroidal neovascularisation (CNV) following previous treatment with photodynamic therapy (PDT). Methods Baseline assessments including best-corrected visual acuity, fluorescein angiography (FFA), and optical coherent tomography (OCT) were performed. Intravitreal ranibizumab and/or bevacizumab were administered on a PRN basis, guided by changes in visual outcome and OCT findings. The follow-up period was at least 6 months. Results 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 (54.36 +/- 15.79-44.24 +/- 17.32 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. Conclusions 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. Eye (2010) 24, 1018-1023; doi: 10.1038/eye.2009.266; published online 6 November 2009