***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To determine if photodynamic therapy with verteporfin ( Visudyne ; Novartis AG , Bülach , Switzerl and ) , termed verteporfin therapy , can safely reduce the risk of vision loss compared with a placebo ( with sham treatment ) in patients with subfoveal choroidal neovascularization caused by age-related macular degeneration who were identified with a lesion composed of occult with no classic choroidal neovascularization , or with presumed early onset classic choroidal neovascularization with good visual acuity letter score . METHODS This was a double-masked , placebo-controlled ( sham treatment ) , r and omized , multicenter clinical trial involving 28 ophthalmology practice s in Europe and North America . The study population was patients with age-related macular degeneration , with subfoveal choroidal neovascularization lesions measuring no greater than 5400 microm in greatest linear dimension with either 1 ) occult with no classic choroidal neovascularization , best-corrected visual acuity score of at least 50 ( Snellen equivalent approximately 20/100 ) , and evidence of hemorrhage or recent disease progression ; or 2 ) evidence of classic choroidal neovascularization with a best-corrected visual acuity score of at least 70 ( better than a Snellen equivalent of approximately 20/40 ) ; assigned r and omly ( 2:1 ) to verteporfin therapy or placebo therapy . Verteporfin ( 6 mg per square meter of body surface area ) or placebo ( 5 % dextrose in water ) was administered by means of intravenous infusion of 30 ml over 10 minutes . Fifteen minutes after the start of the infusion , a laser light at 689 nm delivered 50 J/cm(2 ) by application of an intensity of 600 mW/cm(2 ) over 83 seconds using a spot size with a diameter 1000 microm larger than the greatest linear dimension of the choroidal neovascularization lesion on the retina . At follow-up examinations every 3 months , retreatment with the same regimen was applied if angiography showed fluorescein leakage . The main outcome measure was at least moderate vision loss , that is , a loss of at least 15 letters ( approximately 3 lines ) , adhering to an intent-to-treat analysis with the last observation carried forward to impute for missing data . RESULTS Two hundred ten ( 93 % ) and 193 ( 86 % ) of the 225 patients in the verteporfin group compared with 104 ( 91 % ) and 99 ( 87 % ) of the 114 patients in the placebo group completed the month 12 and 24 examinations , respectively . On average , verteporfin-treated patients received five treatments over the 24 months of follow-up . The primary outcome was similar for the verteporfin-treated and the placebo-treated eyes through the month 12 examination , although a number of secondary visual and angiographic outcomes significantly favored the verteporfin-treated group . Between the month 12 and 24 examinations , the treatment benefit grew so that by the month 24 examination , the verteporfin-treated eyes were less likely to have moderate or severe vision loss . Of the 225 verteporfin-treated patients , 121 ( 54 % ) compared with 76 ( 67 % ) of 114 placebo-treated patients lost at least 15 letters ( P = .023 ) . Likewise , 67 of the verteporfin-treated patients ( 30 % ) compared with 54 of the placebo-treated patients ( 47 % ) lost at least 30 letters ( P = .001 ) . Statistically significant results favoring verteporfin therapy at the month 24 examination were consistent between the total population and the subgroup of patients with a baseline lesion composition identified as occult choroidal neovascularization with no classic choroidal neovascularization . This subgroup included 166 of the 225 verteporfin-treated patients ( 74 % ) and 92 of the 114 placebo-treated patients ( 81 % ) . In these patients , 91 of the verteporfin-treated group ( 55 % ) compared with 63 of the placebo-treated group ( 68 % ) lost at least 15 letters ( P = .032 ) , whereas 48 of the verteporfin-treated group ( 29 % ) and 43 of the placebo-treated group ( 47 % ) lost at least 30 letters ( P = .004 ) . Other secondary outcomes , including visual acuity letter score worse than 34 ( approximate Snellen equivalent of 20/200 or worse ) , mean change in visual acuity letter score , development of classic choroidal neovascularization , progression of classic choroidal neovascularization and size of lesion , favored the verteporfin-treated group at both the month 12 and month 24 examination for both the entire study group and the subgroup of cases with occult with no classic choroidal neovascularization at baseline . Subgroup analyses of lesions composed of occult with no classic choroidal neovascularization at baseline suggested that the treatment benefit was greater for patients with either smaller lesions ( 4 disc areas or less ) or lower levels of visual acuity ( letter score less than 65 , an approximate Snellen equivalent of 20/50(-1 ) or worse ) at baseline . Prospect ively planned multivariable analyses confirmed that these two baseline variables affected the magnitude of treatment benefit . ( ABSTRACT TRUNCATED OBJECTIVE The 2-year , phase III trial design ated Anti-vascular endothelial growth factor ( VEGF ) Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization ( CNV ) in Age-related Macular Degeneration ( ANCHOR ) compared ranibizumab with verteporfin photodynamic therapy ( PDT ) in treating predominantly classic CNV . DESIGN Multicenter , international , r and omized , double-masked , active-treatment-controlled clinical trial . PARTICIPANTS Patients with predominantly classic , subfoveal CNV not previously treated with PDT or antiangiogenic drugs .  INTERVENTION Patients were r and omized 1:1:1 to verteporfin PDT plus monthly sham intraocular injection or to sham verteporfin PDT plus monthly intravitreal ranibizumab ( 0.3 mg or 0.5 mg ) injection . The need for PDT ( active or sham ) retreatment was evaluated every 3 months using fluorescein angiography ( FA ) . MAIN OUTCOME MEASURES The primary , intent-to-treat efficacy analysis was at 12 months , with continued measurements to month 24 . Key measures included the percentage losing < 15 letters from baseline visual acuity ( VA ) score ( month 12 primary efficacy outcome measure ) , percentage gaining > or=15 letters from baseline , and mean change over time in VA score and FA-assessed lesion characteristics . Adverse events were monitored . RESULTS Of 423 patients ( 143 PDT , 140 each in the 2 ranibizumab groups ) , the majority ( > or=77 % in each group ) completed the 2-year study . Consistent with results at month 12 , at month 24 the VA benefit from ranibizumab was statistically significant ( P<0.0001 vs. PDT ) and clinical ly meaningful : 89.9 % to 90.0 % of ranibizumab-treated patients had lost < 15 letters from baseline ( vs. 65.7 % of PDT patients ) ; 34 % to 41.0 % had gained > or=15 letters ( vs. 6.3 % of PDT group ) ; and , on average , VA was improved from baseline by 8.1 to 10.7 letters ( vs. a mean decline of 9.8 letters in PDT group ) . Changes in lesion anatomic characteristics on FA also favored ranibizumab ( all comparisons P<0.0001 vs. PDT ) . Overall , there was no imbalance among groups in rates of serious ocular and nonocular adverse events . In the pooled ranibizumab groups , 3 of 277 ( 1.1 % ) patients developed presumed endophthalmitis in the study eye ( rate per injection = 3/5921 [ 0.05 % ] ) . CONCLUSIONS In this 2-year study , ranibizumab provided greater clinical benefit than verteporfin PDT  in patients with age-related macular degeneration with new-onset , predominantly classic CNV . Rates of serious adverse events were low . FINANCIAL DISCLOSURE(S ) Proprietary or commercial disclosure may be found after the references Purpose This prospect i ve multi-center pilot study compares the use of half-fluence photodynamic therapy combined with ranibizumab with ranibizumab monotherapy for the treatment of neovascular age-related macular degeneration . Methods All patients presenting with untreated subfoveal neovascular age-related macular degeneration were considered for inclusion . Patients were r and omized to receive either ranibizumab with half-fluence photodynamic therapy or ranibizumab alone . Patients in the ranibizumab alone group were given three consecutive monthly ranibizumab injections and were followed monthly . They were treated with ranibizumab as needed , based on clinical discretion , using vision and optical coherence tomography . Patients in the combined group were given one same-day combined ranibizumab and half-fluence ( 25 j/cm2 ) photodynamic therapy treatment and were treated monthly as needed . Outcomes included changes in st and ardized visual acuity , optical coherence tomography foveal thickness , and percentage of as-needed injections to maintenance examinations . Results Fifty-six out of 60 enrolled patients completed the twelve month primary outcome visit ; this consisted of 27 patients receiving ranibizumab alone and 29 receiving combined treatment . The average age was 79.1 for the ranibizumab alone group and 79.3 for the combined group . The mean visual acuity in the ranibizumab alone group improved from 52.9 Early Treatment of Diabetic Retinopathy letters initially to 62.8 letters at twelve months . The mean visual acuity in the combined group improved from 49.2 letters to 51.8 letters at twelve months . The differences in visual acuity improvements were not statistically significant based on a two-tailed t-test ( P = 0.2 ) . Due to the presence of outliers in each group , a Mann – Whitney U test was performed to confirm the results ( U = 325 ; P = 0.28 ) . The mean optical coherence tomography foveal thickness improved 92.5 microns and 106.7 microns in the ranibizumab alone and the combined group , respectively . The difference was not significant based on a two-tailed t-test ( P = 0.6 ) . The ranibizumab alone group received an average of 6.8 injections , while the combined group received an average of three injections . This difference was not significant based on a chi-square test ( P = 0.11 ) . Conclusion The groups appeared similar based on statistical analysis , but larger studies are needed to determine possible small differences between combination therapy and monotherapy Purpose Combination verteporfin photodynamic therapy ( vPDT ) and antivascular endothelial growth factor ( anti-VEGF ) therapy may decrease the need for injections while maintaining visual acuity in exudative age-related macular degeneration . This pilot study was design ed to determine the threshold fluence dose of vPDT ( the dose required to demonstrate an effect on choroidal perfusion ) combined with ranibizumab . Methods Seven patients were r and omized to sham vPDT ( two patients ) , 20 % fluence vPDT ( two patients ) , or 40 % fluence vPDT ( three patients ) in combination with three-monthly intravitreal 0.5 mg ranibizumab injections . Intravitreal ranibizumab was reinjected if disease activity was seen on fluorescein angiography , optical coherence tomography , or clinical examination . Indocyanine green-determined choroidal hypoperfusion was grade d in a masked fashion . Results Patients with 20 % vPDT had mild hypoperfusion defects at seven days that resolved by week 4 ( threshold dose ) ; patients with 40 % fluence vPDT had marked hypoperfusion at seven days that persisted as long as 12 months . Recruitment was stopped after limited efficacy was observed . One patient with 20 % fluence vPDT lost 19 letters at one year ; no other patient lost or gained > 10 letters . Central retinal thickness decreased in six of seven patients , but ranibizumab injections did not decrease . Conclusion This pilot study shows that the threshold fluence dose of vPDT ( when combined with ranibizumab ) is approximately 20 % st and ard fluence , and that mild and transient choroidal hypoperfusion can occur . Forty percent fluence vPDT causes a more prolonged and striking hypoperfusion . Despite hypoperfusion , no decrease in visual acuity or injections required was noted , suggesting that even higher fluence levels of vPDT may be necessary to decrease the number of anti-VEGF injections OBJECTIVE To report 24-month vision and fluorescein angiographic outcomes from trials evaluating photodynamic therapy with verteporfin ( Visudyne ; CIBA Vision Corp , Duluth , Ga ) in patients with subfoveal choroidal neovascularization ( CNV ) caused by age-related macular degeneration ( AMD ) . DESIGN Two multicenter , double-masked , place 
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As major adverse events , the differences in the number of eye pain , endophthalmitis , hypertension and arterial thromboembolic events were not significant between the two groups , and the incidence of serious adverse events in the two groups was very low .
For the maintenance of vision , the comparison of the combination of ranibizumab with PDT vs ranibizumab monotherapy shows no apparent difference .
Compared with the combination of ranibizumab and PDT , patients treated with ranibizumab monothearpy may gain more visual acuity ( VA ) improvement .
The combination treatment group had a tendency to reduce the number of ranibizumab retreatment .
Both the two treatment strategies were well tolerated