Coll. Antropol. 31 (2007) Suppl. 1: 71–75 Professional paper Photodynamic Therapy Combined with Intravitreal Bevacizumab (Avastin) in Treatment of Choroidal Neovascularization Secondary to Age-Related Macular Degeneration Ratimir Lazi}, Nikica Gabri}, Iva Dekaris, Morena Gavri} and Damir Bosnar Eye Clinic »Svjetlost«, Zagreb, Croatia ABSTRACT To evaluate photodynamic therapy with verteporfin combined with intravitreal bevacizumab in minimally classic and occult choroidal neovascularization secondary to age-related macular degeneration. 46 eyes of 46 patients (mean age 74.5) included in this prospective, noncomparative, interventional case series. Median follow-up was 24 weeks (12–36). Verteporfin photodynamic therapy (PDT) was followed by 0.05 mL (1.25 mg) of bevacizumab injected intravitreally within 24 hours and again after 6 weeks. Whole procedure was repeated in 3-month intervals in case of leakage. Visual acuity (VA) improved in majority of patients (baseline VA 1.041 log MAR) by mean increase of 1.45 lines (last follow-up) (p=0.001). Central foveal thickness (CFT) and total macular volume (TMV) decreased by 53 μm (p=0.03) and 1.04 mm 3 (p<0.001) respectively. No serious complications were observed.Combined treatment may improve outcome of monothe- rapy. Significant improvement in VA, CFT and TMA was noted in majority of patients and maintained during fol- low-up. Key words: bevacizumab, photodynamic therapy, choroidal neovascularization Introduction Photodynamic therapy with verteporfin is very effec- tive in patients with classic subfoveal neovascularization due to age related macular disease. 1–3 Also it has shown positive effect in reducing the risk of visual loss in pa- tients with occult choroidal neovascularization, 4 and in minimally classic CNV. 5 Since we noticed from our own clinical experience, verteporfin therapy does not produce too good results in treatment of minimally classic and oc- cult lesions, as in treatment of classical CNV, the further investigation for novel approaches in treatment of such lesion subtypes is fully justified. The positive outcomes of antiVEGF therapy (e.g.pegaptanib) in treatment of neo- vascular AMD have been fully reported in several stud- ies. 6,7 Also, there are clinical studies going on to compare various treatment modalities for neovascular AMD: e.g. verteporfin vs. pegaptanib. New antiVEGF agent, beva- cizumab, has also been used in off-label treatment of neovascular AMD and neovascularization due to patho- logic myopia for a year now. 6,8–10 Bevacizumab, a huma- nized monoclonal antibody directed against vascular en- dothelial growth factor, was already approved by Food and Drug Administration for the treatment of metastatic colorectal cancer. 5,11 Since the pathogenesis of choroidal neovascularization is multifactorial including both angiogenesis, extravaza- tion and inflammation, it is fully justified to try to incor- porate several treatment modalities for combating the dis- eases. There have been studies suggesting the additive effect to verteporfin therapy of anti-inflammatory and anti-angiogenic drugs in treatment of neovascular AMD. 12,13 Since the anti-angiogenic effect of triamcinolone adminis- tered alone is quite weak, 14,15 producing only mild tran- sient effect, and since bevacizumab administered alone did show promising results in treatment of CNV, 6,8–10 it is quite justified trying to combine verteporfin and intra- 71 Received for publication October 1, 2006