David Callanan, MD (Arlington, TX),* Wayne Solley, MD (Arlington, TX)


The purpose of the study is to determine whether the combination of intravitreal Avastin and reduced fluence PDT is as effective as either treatment alone; and whether the combination therapy may reduce the number of treatments needed.


Patients presenting with subfoveal choroidal neovascularization were treated with an intravitreal injection of 1.25 mgs. of Avastin. Five to 14 days later they were treated with reduced fluence photodynamic therapy ( 25 Joules, 300 mW/cm2) using a standard dose of Visudyne. Visual acuity, OCT, and fluorescein angiography (FA) was performed prior to treatment. Visual acuity and OCT measurements were repeated at 4-6 week intervals; and FA as deemed necessary. Retreatment was considered for any decrease in vision and/or evidence of leakage on OCT or angiography.


Twenty-one patients were treated with the combination Avastin and reduced fluence PDT (RFPDT). Ten of the patients had had no prior treatment (naive). Ten patients had been previously treated with combination triamcinolone and PDT and had persistent or recurrent leakage from the choroidal neovascularization as measured by OCT and FA. One patient had been treated with Avastin alone and had evidence of recurrent leakage at 3 months. Fifteen of the patients have a minimun follow-up of 3 months and six of the patients have a minimum follow-up of 2 months. Only one patient has required a repeat treatment and this was at 3 months. No patient has lost 3 or more lines of vision. Twenty of the patients had equal or better vision at the last follow-up. Three of the naive patients (30%) and only one of the previously treated patients gained 3 or more lines. Six of the ten naive patients are 20/40 or better.


Based on a small non-randomized sample, the combination of Avastin and RF-PDT appears to be effective. Patients that had failed previous therapy responded well, but the combination appeared to work better as the initial therapy. The combination of Avastin and PDT may reduce the number of treatments needed while matching the best results obtained with either monotherapy.
* Financial interest disclosed