Combined anti-VEGF and PDT for wet AMD
Reviewed by Brian Ang

The authors report on a retrospective case series of combined anti-VEGF and photodynamic therapy (PDT) in the treatment of wet age-related macular degeneration (AMD) refractory to anti-VEGF monotherapy alone. The criteria for treatment failure of anti-VEGF monotherapy were persistent subretinal fluid or retinal thickening of more than 250 microns on OCT at every time point before PDT and a minimum of three intravitreal injections of anti-VEGF therapy over the previous seven months. All subtypes of choroidal neovascular membranes were included. Patients with subretinal fibrosis, retinal pigment epithelium atrophy, previous retinal laser, and choroidal neovascularisation not related to AMD were excluded from the study. The combined therapy consisted of intravitreal anti-VEGF injection (bevacizumab or ranibizumab) followed by half fluence PDT (300mW, 25J, 83 seconds) with verteporfin within seven days. Visual acuity improved significantly at one month and three months, and showed a trend towards improvement at six months. Retinal thickness decreased significantly at one, three and six months. The interval between treatments increased from once every 1.6 months to once every 2.7 months with combination therapy. No ocular complications were seen with combination therapy. This study, although limited by its retrospective study design and small sample size, shows promising results for the treatment of wet AMD that is non-responsive to anti-VEGF therapy. Larger scale and longer term studies are needed to investigate this further.

Combination therapy for neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor agents.
Tozer K, Roller AB, Chong LP, Sadda SV, et al.
OPHTHALMOLOGY
2013;120:2029-34.