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Low fluence rate photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration
  1. Ciro Costagliola1,
  2. Mario R Romano1,2,
  3. Michele Rinaldi3,
  4. Roberto dell'Omo1,
  5. Flavia Chiosi3,
  6. Massimo Menzione3,
  7. Francesco Semeraro4
  1. 1Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso, Italy
  2. 2St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  3. 3Dipartimento di Oftalmologia, Seconda Università degli Studi di Napoli, Naples, Italy
  4. 4Dipartimento di Oftalmologia, Università degli Studi di Brescia, Brescia, Italy
  1. Correspondence to Dr Mario Romano, Dipartimento di Scienze per la Salute, Via F De Sanctis, 86100 Campobasso, Italy; romanomario{at}


Aims To report the efficacy and safety of intravitreal bevacizumab (IVB) alone versus IVB plus low-fluence photodynamic therapy (PDT) in age-related macular degeneration (AMD) patients and to verify the occurrence of a synergistic effect of the combined approach on visual acuity, size and morphology of lesion, as well as on the treatment rate.

Method Prospective comparative interventional study on 85 patients with treatment-naive classic, or predominantly classic, subfoveal choroidal neovascularisation secondary to AMD. Patients were randomly assigned to group 1 (IVB injections) and group 2 (IVB plus low fluence PDT). In group 2, the PDT with verteporfin was delivered with a low fluence rate (300 mW/cm2 for 83 s, 25 J/cm2). The follow-up was scheduled at 1, 3, 6, 9 and 12 months.

Results The eye without recurrence received a mean of 2.8 (group 1) versus 1.4 (group 2) IVB injections, whereas the eyes with recurrence received a mean of 3.2 (group 1) versus 2.2 (group 2) IVB injections. The difference in reinjection rate between the two groups was statistically significant (p=0.03, ANOVA test). Visual acuity improvement was not statistically significant between the two groups (p=0.31).

Conclusion The combination of IVB with low fluence PDT for the treatment of classic or predominantly classic neovascular AMD works in a synergistic fashion with a significant reduction in IVB reinjections rate.

  • Age-related macular degeneration
  • bevacizumab
  • classic choroidal neovascularisation
  • predominantly classic choroidal neovascularisation
  • low fluence PDT

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  • See Editorial, p 143

  • Linked articles 155531, 159863

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Naples, Italy and University of Brescia, Italy.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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