@article {93,
	title = {Combination Therapy for Neovascular Age-Related Macular Degeneration Refractory to Anti-Vascular Endothelial Growth Factor~Agents.},
	journal = {Ophthalmology},
	year = {2013},
	month = {2013 May 25},
	abstract = {<p>OBJECTIVE: To examine the outcomes of combination anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) for the treatment of neovascular age-related macular degeneration (AMD) refractory to anti-VEGF monotherapy. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Twenty-six eyes of 26 patients treated with anti-VEGF monotherapy for neovascular AMD with persistent subretinal or intraretinal fluid after at least 3 anti-VEGF injections in the 7 months before combination treatment. INTERVENTION: Combination anti-VEGF treatment and PDT. MAIN OUTCOME MEASURES: Visual acuity at 1 or 2, 3, and 6 months and central retinal thickness at 1 or 2, 3, and 6 months. Secondary outcome measures were change in number of fluid-free visits and interval between treatments in the 7 months before and 6 months after combination therapy. RESULTS: Statistically significant improvements in logarithm of the minimum angle of resolution visual acuities were present at 1 month (P~= 0.01) and 3 months (P~= 0.01). Significant decreases in central subfield retinal thickness on optic coherence tomography (OCT) were seen at 1 month (P~= 4{\texttimes}10(-5)), 3 months (P~= 3{\texttimes}10(-4)), and 6 months (P~= 4{\texttimes}10(-5)) as compared with precombination treatment OCT scans. The percentage of patient visits with no subretinal fluid increased from 0.5\% to 41\% after the initiation of combination therapy (P~= 1{\texttimes}10(-5)). The interval between treatments increased from once every 1.6 months in the 7 months before combination treatment to once every 2.7 months in the 6 months after combination treatment (P~= 0.002). No ocular complications attributable to PDT were seen. CONCLUSIONS: Rescue therapy with the combination of anti-VEGF and PDT in eyes that have failed anti-VEGF monotherapy resulted in a mean improvement in vision, a decreased central subfield retinal thickness, and an increase in fluid-free intervals. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p>},
	author = {Tozer, Kevin and Roller, A Brock and Chong, Lawrence P and Sadda, Srinivas and Folk, James C and Mahajan, Vinit B and Russell, Stephen R and Boldt, H Culver and Sohn, Elliott H}
}
