To evaluate the effect of concomitant systemic therapy in patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated by intravitreal bevacizumab and to propose a mechanism for different interindividual response, investigators performed this retrospective, nonrandomized, single-center, consecutive interventional case series study.

They treated 46 eyes from 46 patients with CNV secondary to AMD by monthly intravitreal 1.25 mg bevacizumab injections on a pro re nata regimen. They also recorded changes in Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), central foveal thickness as determined by spectral domain optical coherence tomography, number of injections performed, occurrence of severe adverse effects and systemic concomitant medication. Additionally, they evaluated the effect of systemic medication on final BCVA, central foveal thickness and number of injections performed.

The investigators reported that the most frequent systemic medications recorded were angiotensin-converting-enzyme inhibitors in 19 patients, beta-adrenergic blocking agents (n=18), nonsteroidal anti-inflammatory drugs (n=17), diuretics (n=16), calcium channel blockers (n=14), benzodiazepines (n=11), proton-pump inhibitors (n=9) and statins (n=8). They noted that 32 patients had arterial hypertension. Average follow-up was 25.1 months (standard deviation [SD]=8.9) and average gain in BCVA was 0.9 (SD=13.6) and –2.1 letters (SD=15.9) at 12 months and 24 months, respectively. The investigators also noted that the average reduction in central foveal thickness was 111 µm (SD=54) and 105 µm (SD=71) at 12 months and 24 months, respectively. The average number of intravitreal injections required was 6.7 (SD=3.2). Furthermore, patients on treatment with systemic beta-adrenergic blocking agents required less intravitreal injections (5.2, SD=2.4 vs. 7.9, SD=3.4) and this difference was statistically significant (p=0.0068, multiple linear regression).

The study investigators concluded that concomitant systemic beta-adrenergic blocking agents treatment may reduce the need for repeated intravitreal injections of bevacizumab in patients with choroidal neovascularization associated with AMD.

The following retrospective Korean study evaluated the five-year efficacy of photodynamic therapy (PDT) in patients with polypoidal choroidal vasculopathy (PCV).

A total of 42 eyes of 36 patients with PCV followed up for at least 60 months after PDT were reviewed. All eyes were primarily treated with PDT. Main outcome measure was best-corrected visual acuity (BCVA; logarithm of minimal angle of resolution [logMAR]) at baseline and at each follow-up visit. The eyes were also classified into three groups: improved (improvement ≥0.3 logMAR), decreased (deterioration ≥0.3 logMAR) and stable.

It was determined that during the mean follow-up duration, 73.64 ± 13.47 months, the mean number of PDT was 2.21 ± 1.62 treatments. Recurrence was noted in 33 eyes (78.6%) during follow-up. Moreover, the mean baseline BCVA was 0.78 ± 0.48 logMAR (20/120 Snellen equivalent), and the final BCVA at 60 months was 0.67 ± 0.52 logMAR (20/93 Snellen equivalent) (p=.050, paired t test). On the final evaluation at 60 months, the mean BCVA was improved in 14 eyes (33.3%), stable in 23 eyes (54.8%) and decreased in five eyes (11.9%).

At 60 months after initial PDT, 88.1% of PCV patients showed stable or improved BCVA after PDT. Despite a high recurrence rate, PDT remained effective for five years, and represents a good therapeutic approach to PCV.

The authors of the following study sought to evaluate the efficacy of reduced-fluence photodynamic therapy (RFPDT) for central serous chorioretinopathy (CSC). They determined that RFPDT appears to be an effective treatment method for CSC and that outer nuclear layer (ONL) thickness is an important visual predictive factor of RFPDT for CSC.

This retrospective medical record review of consecutive CSC patients treated with RFPDT (full-dose verteporfin and laser fluence of 25 J/cm²) examined 22 eyes of 21 patients (20 males and one female). The authors followed all patients for one year and evaluated best-corrected visual acuity (BCVA), complete resolution of subretinal fluid (CR of SRF), central retinal thickness (CRT), the outer nuclear layer (ONL) thickness and the photoreceptor inner and outer segments (IS/OS) line determined by optical coherence tomography imaging at baseline, one, three, six, nine and 12 months after initial RFPDT.

The study authors performed a single RFPDT session in all cases during a 12-month period. They identified CR of SRF in all patients. They also observed that BCVA significantly improved between three and 12 months (p<0.05). According to the authors, the CRT significantly decreased between one and 12 months. They observed a significantly thicker ONL at one month, and 17 eyes (77.2%) showed recovery of the continuous foveal IS/OS line. The authors of this study determined that ONL thickness was correlated with BCVA at 12 months (p<0.01). Stepwise analysis indicated that pre-treatment BCVA (p<0.01) and ONL thickness (p<0.01) were significant predictive factors for BCVA at 12 months. Neither ocular nor systemic adverse effects were observed during the follow-up period.