Fast Five Quiz: Exudative (Wet) Age-Related Macular Degeneration Management

F. Ryan Prall, MD


November 05, 2020

Results from treatment with anti-VEGF agents have been promising, although there continues to be a subset of patients who have disappointing visual outcomes. In some cases, different forms of macular degeneration, such as polypoidal vasculopathy and retinal angiomatous proliferation, may respond dissimilarly to anti-VEGF agents.

Because evidence exists that PDT causes an increased expression of VEGF, several studies have evaluated the theoretical synergistic advantage of various combinations of PDT and anti-VEGF treatments.

In one study, the efficacy of reduced-fluence PDT combined with anti-VEGF vs anti-VEGF monotherapy was tested. The study found that the number of injections needed in the combination groups was reduced by about half, without significant differences in visual outcome. However, in another study using standard fluence, visual acuity in the combination group was similar to that achieved with monthly anti-VEGF therapy, but there was no decrease in the number of anti-VEGF injections required.

Likewise, in the DENALI study, anti-VEGF therapy improved best-corrected visual acuity at month 12 as monotherapy or combined with verteporfin PDT. However, the study did not demonstrate that combination regimens were noninferior to the VEGF inhibitor monotherapy. Most recently, results from the EVEREST II study demonstrated visual acuity gains and fewer intravitreal injections for patients with polypoidal vasculopathy.

Learn more about treatment with combination therapy for wet AMD.


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