Intravitreal Ranibizumab and Bevacizumab in Combination with Full-Fluence Verteporfin Therapy and Dexamethasone for Exudative Age-Related Macular Degeneration
Abstract:Purpose: To evaluate the efficacy and safety of triple therapy with intravitreal anti-vascular-endothelial-growth-factor (VEGF) antibody, dexamethasone and verteporfin photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD). Methods: Retrospective, comparative, interventional study. Records of treatment-naïve patients who received intravitreal bevacizumab or ranibizumab in monotherapy or in combination with dexamethasone and full-fluence verteporfin PDT in triple therapy were reviewed. … Show more
“…A single session of TT led to complete resolution of angiographic evidence of CNV in 77.8% of cases [10]. Forte et al [12] reviewed retrospectively the efficacy of PDT-V (50 J/cm 2 ), intravitreal dexamethasone and ranibizumab or bevacizumab in 21 eyes. They reported a significant improvement of VA and foveal thickness with a mean follow-up of 14 months.…”
Section: Discussionmentioning
confidence: 99%
“…Combination therapy with anti-VEGF agents, steroids and PDT-V has been proposed to interfere with multiple stimuli to pathologic vascular proliferation while reducing treatment frequency [8,9,10,11]. In previously published triple-therapy studies, PDT-V light fluence ranged from 25 to 50 J/cm 2 [8,9,10,11,12,13,14]. It has been shown that reducing the fluence and/or irradiance of light delivered can enhance the selectivity of PDT-V treatment, avoiding collateral damage to the physiologic choroid [15].…”
Purpose: To evaluate the safety and exploratory efficacy of triple therapy (TT) with single-session intravitreal ranibizumab, modified juxtascleral triamcinolone, and photodynamic therapy (PDT) in exudative age-related macular degeneration non-responder to anti-vascular endothelial growth factor. Methods: Thirty consecutive eyes were included. The first 10 eyes (cohort 1) enrolled received same-day TT with reduced-fluence/reduced-irradiance PDT, 10 eyes (cohort 2) received same-day TT with reduced-fluence/standard irradiance PDT, the last 10 eyes (cohort 3) received same-day TT with standard fluence/standard irradiance PDT. Results: All patients completed the 6-month follow-up. Mean best corrected visual acuity (BCVA) at baseline was 1.1 (cohort 1), 0.9 (cohort 2) and 1.1 (cohort 3) logMAR. After 6 months, mean BCVA change was -0.15 (not significant), -0.13 (not significant) and 0.29 (p < 0.05) logMAR, respectively. Among eyes treated with standard fluence/standard irradiance PDT, 2 showed choroidal ischemia. Conclusions: The combination of modified juxtascleral triamcinolone, reduced-fluence PDT, and ranibizumab appears as a safe treatment option.
“…A single session of TT led to complete resolution of angiographic evidence of CNV in 77.8% of cases [10]. Forte et al [12] reviewed retrospectively the efficacy of PDT-V (50 J/cm 2 ), intravitreal dexamethasone and ranibizumab or bevacizumab in 21 eyes. They reported a significant improvement of VA and foveal thickness with a mean follow-up of 14 months.…”
Section: Discussionmentioning
confidence: 99%
“…Combination therapy with anti-VEGF agents, steroids and PDT-V has been proposed to interfere with multiple stimuli to pathologic vascular proliferation while reducing treatment frequency [8,9,10,11]. In previously published triple-therapy studies, PDT-V light fluence ranged from 25 to 50 J/cm 2 [8,9,10,11,12,13,14]. It has been shown that reducing the fluence and/or irradiance of light delivered can enhance the selectivity of PDT-V treatment, avoiding collateral damage to the physiologic choroid [15].…”
Purpose: To evaluate the safety and exploratory efficacy of triple therapy (TT) with single-session intravitreal ranibizumab, modified juxtascleral triamcinolone, and photodynamic therapy (PDT) in exudative age-related macular degeneration non-responder to anti-vascular endothelial growth factor. Methods: Thirty consecutive eyes were included. The first 10 eyes (cohort 1) enrolled received same-day TT with reduced-fluence/reduced-irradiance PDT, 10 eyes (cohort 2) received same-day TT with reduced-fluence/standard irradiance PDT, the last 10 eyes (cohort 3) received same-day TT with standard fluence/standard irradiance PDT. Results: All patients completed the 6-month follow-up. Mean best corrected visual acuity (BCVA) at baseline was 1.1 (cohort 1), 0.9 (cohort 2) and 1.1 (cohort 3) logMAR. After 6 months, mean BCVA change was -0.15 (not significant), -0.13 (not significant) and 0.29 (p < 0.05) logMAR, respectively. Among eyes treated with standard fluence/standard irradiance PDT, 2 showed choroidal ischemia. Conclusions: The combination of modified juxtascleral triamcinolone, reduced-fluence PDT, and ranibizumab appears as a safe treatment option.
“…A few other reports have suggested a possible role of dexamethasone in combination with anti-VEGF therapies [45,46]. Studies exploring the combination of verteporfin PDT, anti-VEGF and intravitreal dexamethasone failed to show superior visual outcomes when compared to anti-VEGF monotherapy [47][48][49].…”
While intravitreal anti-vascular endothelial growth factor (VEGF) therapy is currently the standard of care for the treatment of neovascular age-related macular degeneration, there are some eyes which show varying degrees of treatment resistance manifested as persistent or increasing signs of exudation, often associated with vision loss. Numerous therapeutic strategies have been proposed to manage these challenging cases including increasing the dose of the same anti-VEGF agent, increasing the frequency of administration of anti-VEGF therapy, switching to a different anti-VEGF agent, and combining anti-VEGF therapy with another treatment modality, most commonly verteporfin photodynamic therapy. This manuscript will review our definition of treatment resistance, discuss its possible causes, and review the rationale and outcomes for the various management options used in these patients.
“…A recent study (Forte et al, 2011) compared PDT + dexamethasone + anti-VEGF (Ranibizumab or Bevacizumab) triple therapy with Ranibizumab or Bevacizumab monotherapy. Sixty-one eyes were included in the first group and 40 in the second.…”
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