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Photodynamic therapy in the anti-VEGF era
  1. Howard F Fine
  1. Correspondence to: Dr H F Fine Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, 635 West 165th Street, New York City, NY 10032, USA; h_f_fine{at}yahoo.com

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An insight as to how photodynamic therapy might play a role in new therapeutic armamentarium

With new, highly effective therapies such as ranibizumab1,2 (Lucentis), bevacizumab3 (Avastin) and many promising treatments on the horizon for choroidal neovascularisation (CNV) due to age-related macular degeneration (AMD), this is an exciting time for retina specialists. Recently published results from the ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) trial demonstrated that for the treatment of classic subfoveal CNV, Lucentis is superior to photodynamic therapy (PDT) with verteporfin (Visudyne) in preventing vision loss and also in improving visual acuity.4 A recent survey revealed that retina specialists have rapidly adopted Lucentis and/or Avastin as their primary therapy of choice. In fact, <1% of respondents were usually recommending PDT as monotherapy for the treatment of subfoveal CNV due to AMD in their well-insured patients.5 This raises the question whether studies on PDT monotherapy for AMD are now only of historical interest?

The answer remains a resounding no. Access to treatments such as Lucentis and Avastin that block vascular endothelial growth factor (VEGF) remains limited or non-existent in some countries. Recent concerns about systemic toxicity including cerebrovascular accident (http://www.fda.gov/medwatch/safety/2007/Lucentis_DHCP_01-24-2007.pdf) could theoretically limit the use of anti-VEGF therapies in select patients who are at a high risk of arterial thromboembolic events. When anti-VEGF therapies are available, retina specialists are faced with many difficult management questions: deciding whether to switch patients …

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