Comparison of Lucentis monotherapy vs. combination therapy for neovascular AMD

Purpose To compare the efficacy of neovascular AMD(NAMD) treatment options by monthly Lucentis(L)(monotherapy), combination therapy utilizing RF‐PDT(P), and Lucentis combined with Kenalog(LK). Methods IRB‐approved retrospective chart review of therapies administered only as‐needed over 20 months. Inclusion criteria: active primary/recurrent subfoveal or juxtafoveal CNV (all types); Snellen BCVA ≥20/400. Exclusion criteria: f/u <3 months or noncompliance; subfoveal atrophy/fibrosis. Kenalog offered with Lucentis when active PED or subretinal fibrosis threatening fovea. RF‐PDT combined with Avastin ± Kenalog(PA±K) or Kenalog alone(PK). Primary outcome measure: mean change in Snellen VA from baseline at last f/u. Secondary outcome measures: incidence of moderate/severe VA change; resolution of leakage; treatment‐free interval. Results 21 eyes received L; 16 eyes LK; 10 eyes RF‐PDT (5 PA±K; 5 PK). Mean f/u was 8.8 (range 3–18) months. At last f/u, mean Snellen VA for L improved ‐0.25; RF‐PDT remained stable +0.06 overall (although PA±K improved ‐0.135; PK worsened +0.27); LK worsened +0.13 logMAR units (p=0.02 for L vs. LK). VA loss <15 letters was greater for L>PA±K>LK>PK, occurring 91%, 80%, 75%, 60%, respectively. 14% L gained ≥30 letters. 20% PK lost ≥30 letters. Leakage resolved greater for L>PA±K>LK>PK, occurring 86%, 80%, 69%, 40%, respectively. Conclusion At intermediate‐term f/u, Lucentis monotherapy administered only as‐needed had results similar to larger studies and was the most effective in maintaining or improving VA in NAMD. Lucentis monotherapy had the greatest leakage resolution and treatment‐free interval. RF‐PDT with Avastin was more effective than with Kenalog alone. Kenalog supplementation to Lucentis unlikely provided added benefit.