Intravitreal anti-vascular endothelial growth factor therapy versus photodynamic therapy for idiopathic choroidal neovascularization

Am J Ophthalmol. 2013 Apr;155(4):713-9, 719.e1. doi: 10.1016/j.ajo.2012.10.010. Epub 2012 Dec 7.

Abstract

Purpose: To compare visual outcomes after intravitreal anti-vascular endothelial growth factor (VEGF) injection or photodynamic therapy (PDT) for idiopathic choroidal neovascularization (CNV).

Design: Retrospective study.

Methods: Among 29 eyes (28 patients), 15 eyes (15 patients) received anti-VEGF therapy and 14 eyes (13 patients) received PDT. Best-corrected visual acuity (BCVA, logMAR [logarithm of minimal angle of resolution]) at baseline and 1, 3, 6, 12, and 24 months after initial treatment were compared. The eyes were classified by BCVA changes: improved (improvement ≥0.3 logMAR), decreased (deterioration ≥0.3 logMAR), and stable.

Results: Mean BCVA was 0.56 ± 0.38 logMAR (20/72 in Snellen equivalent) in the PDT group and 0.44 ± 0.59 logMAR (20/55 in Snellen equivalent) in the anti-VEGF group at baseline (P = .104, Mann-Whitney U test). The anti-VEGF group showed significantly better mean BCVA at each follow-up visit when compared with that of PDT (P = .004 at 1 month, P = .002 at 3 months, P = .037 at 6 months, P = .031 at 12 months, and P = .049 at 24 months; Mann-Whitney U test, respectively). When compared with the baseline, mean BCVA at each follow-up visit was better in the anti-VEGF group (P = .196 at 1 month, P = .007 at 3 months, P = .046 at 6 months, P = .046 at 12 months, and P = .049 at 24 months; Wilcoxon signed rank test, respectively), whereas BCVA in the PDT group was not. At 24 months, all eyes (100.0%) treated with anti-VEGF showed stable or improved BCVA, whereas 3 eyes (21.3%) showed visual deterioration after PDT.

Conclusions: Anti-VEGF therapy was superior to PDT for idiopathic CNV, and superior efficacy was sustained until 24 months.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Bevacizumab
  • Choroidal Neovascularization / drug therapy*
  • Choroidal Neovascularization / physiopathology
  • Coloring Agents
  • Female
  • Fluorescein Angiography
  • Humans
  • Indocyanine Green
  • Intravitreal Injections
  • Male
  • Middle Aged
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use
  • Porphyrins / therapeutic use
  • Ranibizumab
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors*
  • Verteporfin
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • Coloring Agents
  • Photosensitizing Agents
  • Porphyrins
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Verteporfin
  • Bevacizumab
  • Indocyanine Green
  • Ranibizumab