Does lesion size determine the success rate of photodynamic therapy for age-related macular degeneration?

Sivaprasad, Sobha; Saleh, George M.; Jackson, Heather

doi:10.1038/sj.eye.6701787

Cited by 12 publications

(10 citation statements)

References 6 publications

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“…SIGHT also compared the effects of treatment in prespecified subgroups based on age and size of active CNV lesions as previous reports suggest that lesion size and age might be predictive for the success of PDT. 10 In this article, we report the primary outcome from SIGHT (mean change in best-corrected visual acuity [BCVA] at week 28), and the final 52-week efficacy and safety outcomes in all patients, including subgroups.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Aflibercept Versus Photodynamic Therapy in Chinese Patients with Neovascular Age-Related Macular Degeneration: Outcomes of the SIGHT Study

LIXiao-xin

ChenYouxin

ZhangJunjun

et al. 2017

Journal of Ocular Pharmacology and Therapeutics

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Purpose: SIGHT compared intravitreal aflibercept injections (IAI) with photodynamic therapy (PDT) in Chinese patients with predominantly classic choroidal neovascularization (CNV) secondary to neovascular age-related macular degeneration (nAMD).Methods: Patients were randomized 3:1 to IAI (2 mg every 8 weeks after 3 initial monthly injections)/sham PDT or active PDT/sham IAI (with switch to IAI at week 28). We report the primary outcome (mean change in best-corrected visual acuity [BCVA] at week 28) and final 52-week outcomes.Results: Patients were randomized to IAI (n = 228) or PDT (n = 76) (mean age: 65.1 years). Mean BCVA change was +14.0 (IAI) versus +3.9 letters (PDT→IAI) (week 28) and +15.2 versus +8.9 letters (between-group difference: 6.2 letters; P = 0.0009) (week 52); mean reduction in central retinal thickness was −189.6 versus −170.0 μm (week 52). The greatest improvements in BCVA with IAI were in youngest patients (<65 years), and in those with a smaller active component of the CNV lesion (<50% of lesion size). The most common ocular treatment-emergent adverse events (study eye; IAI vs. PDT→IAI) were macular fibrosis (11.8% vs. 6.6%) and visual acuity reduced (6.6% vs. 21.1%). Three treatment-emergent Antiplatelet Trialists' Collaboration-defined arterial thromboembolic events were observed but none was considered drug related.Conclusions: IAI demonstrated superiority over PDT in Chinese nAMD patients. The benefits of IAI were maintained through week 52 in all patients, including subgroups, and in patients who switched from PDT to IAI. The incidence of adverse events was consistent with the known safety profile of IAI. Trial registration number NCT01482910.

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Section: Introductionmentioning

confidence: 99%

Intravitreal Aflibercept Versus Photodynamic Therapy in Chinese Patients with Neovascular Age-Related Macular Degeneration: Outcomes of the SIGHT Study

LIXiao-xin

ChenYouxin

ZhangJunjun

et al. 2017

Journal of Ocular Pharmacology and Therapeutics

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“…Eyes that develop fibrosis after photodynamic therapy for CNV have poor vision outcomes. 5 Scar that develops after radiotherapy for nvAMD has been described. 6,7 However, treatment patterns for nvAMD have changed in the past decade, and nearly all patients now receive treatment with intravitreal injections of drugs that target vascular endothelial growth factor (VEGF).…”

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confidence: 99%

Risk of Scar in the Comparison of Age-related Macular Degeneration Treatments Trials

et al. 2014

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Objective To describe risk factors for scar in eyes treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). Design Prospective cohort study within a randomized clinical trial. Participants Patients with no scar on color fundus photography (CFP) or fluorescein angiography (FA) at enrollment in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Methods Eyes were assigned to ranibizumab or bevacizumab treatment and to 1 of 3 dosing regimens for 2 years. Masked readers assessed CFP and FA. Baseline demographic characteristics, visual acuity, morphologic features on photography and optical coherence tomography (OCT), and genotypes associated with AMD risk were evaluated as risk factors using adjusted hazard ratios (aHRs) and associated 95% confidence intervals (CIs). Scars were classified as fibrotic with well-demarcated elevated mounds of yellowish white tissue or nonfibrotic with discrete flat areas of hyperpigmentation with varying amounts of central depigmentation. Main Outcome Measures Scar formation. Results Scar developed in 480 of 1059 eyes (45.3%) by 2 years. Baseline characteristics associated with greater risk of scarring were predominantly classic choroidal neovascularization (CNV) (aHR, 3.1; CI, 2.4–3.9) versus occult CNV, blocked fluorescence (aHR, 1.4; CI, 1.1–1.8), foveal retinal thickness >212 μm (aHR, 2.4; CI, 1.7–3.6) versus <120 μm, foveal subretinal tissue complex thickness >275 μm (aHR, 2.4; CI, 1.7–3.6) versus ≤75 μm, foveal subretinal fluid (aHR, 1.5; CI, 1.1–2.0) versus no subretinal fluid, and subretinal hyperreflective material (SHRM) (aHR, 1.7; CI, 1.3–2.3) versus no SHRM. Eyes with elevation of the retinal pigment epithelium had lower risk (aHR, 0.6; CI, 0.5–0.8) versus no elevation. Drug, dosing regimen, and genotype had no statistically significant association with scarring. Fibrotic scars developed in 24.7% of eyes, and nonfibrotic scars developed in 20.6% of eyes. Baseline risk factors for the scar types were similar except that eyes with larger lesion size or visual acuity <20/40 were more likely to develop fibrotic scars. Conclusions Approximately half of eyes enrolled in CATT developed scar by 2 years. Eyes with classic neovascularization, a thicker retina, and more fluid or material under the foveal center of the retina are more likely to develop scar.

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“…7,9,10 The subject eyes in these studies did not show PCV, but exudative AMD, and the FA-guided GLD was used to compare the lesion size with the fi nal BCVA. In the present study, we also found a signifi cant correlation between the IA-guided GLD and the fi nal BCVA (r = −0.401, P = 0.0097, Pearson correlation) among all 40 cases.…”

Section: Discussionmentioning

confidence: 99%

Photodynamic therapy for polypoidal choroidal vasculopathy: Baseline perimetric results and visual outcomes

et al. 2009

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Does lesion size determine the success rate of photodynamic therapy for age-related macular degeneration?

Cited by 12 publications

References 6 publications

Intravitreal Aflibercept Versus Photodynamic Therapy in Chinese Patients with Neovascular Age-Related Macular Degeneration: Outcomes of the SIGHT Study

Intravitreal Aflibercept Versus Photodynamic Therapy in Chinese Patients with Neovascular Age-Related Macular Degeneration: Outcomes of the SIGHT Study

Risk of Scar in the Comparison of Age-related Macular Degeneration Treatments Trials

Photodynamic therapy for polypoidal choroidal vasculopathy: Baseline perimetric results and visual outcomes

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