Effect of anti-VEGF drugs combined with photodynamic therapy in the treatment of age-related macular degeneration

Abstract

We analyzed the effects of anti-vascular endothelial growth factor (VEGF) drugs combined with photodynamic therapy (PDT) in the treatment of age-related macular degeneration (AMD). Ninety-six cases (192 eyes) of AMD were included in this study and randomly divided into the observation group and control group (n=48 cases per group). The control group was administered the treatment of Lucentis intravitreal injection alone and the observation group was administered Lucentis combined with PDT. The therapeutic effects were compared. The best corrected visual acuity of patients in the two groups increased gradually after treatment. Patients in the observation group had a significantly higher visual acuity when compared to the control group 1 and 6 months post-operation. The differences were statistically significant (P<0.05). The proportion of patients with vision improvement in the observation group was higher than that in the control group from 1 to 6 months; differences were statistically significant (P<0.05). Through detection by color Doppler ultrasound within 6 months after treatment, we observed that the peak systolic velocity and arterial end diastolic velocity of retrobulbar optic nerve bitemporal PCA of the observation group were higher than those of the control group. The values of arterial resistance index and pulsatility index of the observation group were lower than those of control group. The differences were statistically significant (P<0.05). Six months after treatment, the value of central foveal thickness of the observation group was lower than that of the control group, the value of mean sensitivity of visual field parameter 10° and 4° was higher in the observation group than in the control group, and the absolute value of mean defects in the observation group were lower than that of the control group. In summary, the differences were statistically significant (P<0.05). Anti-VEGF drugs combined with PDT can optimize the overall vision of patients with AMD, improve hemodynamic parameters and reduce visual field defects.

Comparative efficacy and safety of anti-vascular endothelial growth factor regimens for neovascular age-related macular degeneration: systematic review and Bayesian network meta-analysis

“…10,64 Likewise, the evidence that the effect of PDT and anti-VEGF combination therapy, which can potentially decrease the number of anti-VEGF injections needed to be effective for achieving BCVA gain and CRT reduction, is comparable with that of anti-VEGF monotherapy had been indicated in several studies. 9,11,65,66 Our analysis includes several unpublished studies, which reduced publication bias.…”

Impact of methylenetetrahydrofolate reductase C677T polymorphism on the efficacy of photodynamic therapy in patients with neovascular age-related macular degeneration

“…Clinical investigations comparing the anti-VEGF/PDT-V combination with the anti-VEGF monotherapy always showed a lower necessity of anti-VEGF re-injection in the combination study groups 35–44,112 , whereas the mean BCVA gain has been often higher in the groups of patients exclusively treated with anti-VEGF drugs in comparison with those undergoing combined approach 36–38,112 . An ideal therapeutic management of a pathologic condition requiring a long-term patient’s take-in-charge, such as AMD-related CNV, should be able to individually select the most efficient strategies and the most efficient regimen for each of them, to reduce the gap between the need of patient-centered care and the actual care’s feasibility inside the healthcare provider.…”

“…Although PDT-V is no longer used as first-line therapy for neovascular AMD, the appraisal of its role as adjunctive treatment to anti-VEGF drugs has not yet led to a harmonized decision-making process 32,33,110 , generating heterogeneous clinical data 35–44,112 which could find meaning through a new personalized pharmacogenetic approach for PDT-V application that might be inclusive of fundus autofluorescence imaging to inspect RPE atrophy 98–103 and optical coherence tomography angiography to decide on single or combined retreatment. Consequently, predictive data on CNV response to PDT-V mono-therapy can represent the bases on which rationally expand our knowledge to optimize the modalities of synergistic combination between anti-VEGF and PDT-V effects 32,50,111,113,114 .…”

“…monthly, pro-re-nata or proactive regimes of intravitreal injections of anti-VEGF drugs) 27–31 . However, because of the critical drawback due to the growing burden of anti-VEGF drugs employment during the real-life clinical practice 32–34 , PDT-V has been combined with anti-VEGF in several different manners, allowing variable diminutions of anti-VEGF re-treatments 35–44 but, in some protocols, also increasing the number of patients who experienced a minor visual gain than those treated with anti-VEGF alone 36–38 . Despite a huge debate on the need of improving the therapeutic management of neovascular AMD, the possible customization of PDT-V has not been fully explored to improve the decision-making process about this photothrombotic procedure targeting AMD-related CNV 32,33 .…”

Excited State and Reactive Oxygen Species against Cancer and Pathogens: A Review on Sonodynamic and Sono‐Photodynamic Therapy

“…Due to those facts, merging PDT and SDT with growth‐factor targeting therapies can potentially increase the long‐term therapeutic effects [46,47] . However, those effects are not related only to cancer [48–50] …”