Original article
Intravitreal Anti–Vascular Endothelial Growth Factor Therapy Versus Photodynamic Therapy for Idiopathic Choroidal Neovascularization

https://doi.org/10.1016/j.ajo.2012.10.010Get rights and content

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.

Section snippets

Enrollment of Study Subjects

A retrospective review was conducted of the medical records of 29 eyes of 28 patients with naïve idiopathic CNV who received intravitreal bevacizumab or ranibizumab injections or PDT alone between March 1, 2005 and February 28, 2009 at the Department of Ophthalmology, Yonsei University Medical Center, Seoul, Korea. Informed consent was obtained from all participants. This retrospective study was performed with the approval of the Institutional Review Board of Yonsei University College of

Baseline Characteristics

A total of 29 eyes of 28 patients with naïve idiopathic CNV were included in the study. Mean age at diagnosis was 35.12 ± 8.87 years (range 20-47 years), and there were 11 male and 17 female patients. All eyes were phakic. Mean spherical equivalent refractive error was −1.75 ± 3.26 diopters, and mean axial length was 25.23 ± 0.50 mm. Mean GLD was 940.5 ± 183.5 μm, and all eyes (100.0%) showed dark rim on ICGA through late phases. The location of idiopathic CNV was subfoveal in 11 eyes (37.9%)

Discussion

Both PDT and anti-VEGF therapy have been effective for treatment of idiopathic CNV. However, optimal treatment for idiopathic CNV has been unclear to date because of a lack of randomized clinical trials. Current studies suggest that anti-VEGF therapy seems to be better for idiopathic CNV,17, 18, 19, 20, 21, 22 because some studies reported rather inconsistent results after PDT.5, 6, 7, 8 Complications of PDT, such as RPE damage, also raised concerns.9 However, most previous studies did not

Hae Min Kang, MD, graduated from Yonsei University College of Medicine in 2007 where she completed internship and residency in 2012. She is currently pursuing a retinal fellowship in Yonsei University Severance Hospital, Seoul, South Korea. Her research interests include macular diseases, including age-related macular degeneration, especially polypoidal choroidal vasculopathy, and myopic choroidal neovascularization.

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    Hae Min Kang, MD, graduated from Yonsei University College of Medicine in 2007 where she completed internship and residency in 2012. She is currently pursuing a retinal fellowship in Yonsei University Severance Hospital, Seoul, South Korea. Her research interests include macular diseases, including age-related macular degeneration, especially polypoidal choroidal vasculopathy, and myopic choroidal neovascularization.

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