148
Figure 5 - Vascularized PED with choroidal neovascularization before and after PDT: RPE tear (fluorescein angiography and OCT)
A
B
and scanty response to the treatment frequently invali-
date our attempts to heal the lesion. RPE tears and sub-
retinal hemorrhages are reported to complicate ranibi-
zumab and bevacizumab treatments
(51-57)
. Moreover, the
sub-RPE fluid hardly responds to the anti-VEGF ther-
apy, probably due to the hydroconductivity changes of
Bruch’s membrane
(68)
. In a recent retrospective case series
of 328 patients treated with bevacizumab, ranibizumab,
pegaptanib and PDT+IVTA respectively, after a mean
follow-up of 42, 4 weeks the authors reported a significant
stabilization of visual acuity in each group, better in the
bevacizumab and ranibizumab ones compared to the
other two, and an overall RPE tears frequency of 12,5%.
However, they conclude that with these treatments, only
a partial regression of the lesions can be obtained, and
the risk of RPE tears is not avoided
(68)
. In the future, new
combination therapies and new therapeutic strategies,
tested in multicentric clinical trials specifically designed,
will help to improve the prognosis of the patients affected
by vascularized PED.
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