Comparison of intravitreal Pegaptanib Sodium monotherapy, Photodynamic therapy and low fluence Photodynamic therapy combinations in the treatment of Age-related macular degeneration

Purpose: To compare the efficacy of intravitreal pegaptanib sodium monotherapy, photo-dynamic therapy (PDT) and low fluence PDT combinations in the treatment of age-related macular degeneration (AMD).Methods: 45 previously untreated eyes of 45 patients with AMD whose best-corrected visual acuities (BCVA) equal or over 0.3 (Snellen) were enrolled in the study. 15 patients in Group I underwent low fluence PDT (25 J/cm2; 300 mW/cm2; 83 sn) and intravitreal pegaptanib sodium combination, 15 patients in Group II underwent PDT according to standart protocol (50 J/cm2; 600 mW/cm2; 83 sn) and intravitreal pegaptanib sodium combination while, 15 patients in Group III underwent intravitreal pegaptanib sodium alone for the treatment of exudative AMD. Complete ophthalmologic examination, optic coherence tomography (OCT) and fluorescein angiography (FA) were performed in pre and post treatment visits. The results of examinations were used in statistical analysis. Before the treatment and at the final follow-up visit, a clinical activity score was calculated for each lesion by using changes in the lesion size, amount of hemorrhage, staining pattern in FA and OCT measurement of intra/subretinal fluid. ? 3 logMAR lines of decrease in BCVA and decrease in clinical activity scores were considered as successful treatment.Results: A total of 45 patients participated in this study, 19 were women (42.2%) and 26 were men (57.8%); the mean age was 72.82±8.02 years (50 ? 87). Mean follow-up was 13.93±5.87 months (6 ? 24). Lesion type was occult in 28 eyes (62.2%). Treatment success rates according to BCVA assessments were 86.7% in Group I, 80% in Group II and 60% in Group III (p>0.05). Among the groups, mean BCVA decrease during the follow-up period were found as 0.3, 1.0 and 2.2 logMAR lines, respectively. There was no statistical significance according to the changes in central macular thickness among the study groups (p=0.850). The rates of the patients with reduced clinical activity scores were found 86.7%, 86.7% and 73.3% in the Group I, II and III, respectively (p>0.05). Patients treated with combination regimens had lower intravitreal injection rates than subjects in monotherapy group (p=0.015).Conclusion: Combination regimen with low fluence PDT and intravitreal pegaptanib sodium injection was found safe and effective in stabilizing the visual acuity and reducing the clinical activity in exudative AMD.Key words: Age-related macular degeneration, photodynamic therapy, low fluence PDT, anti-VEGF