Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia

Abstract

This retrospective, interventional case series analyses treatment outcomes in eyes with choroidal neovascularization (CNV) secondary to pathological myopia, managed with photodynamic therapy, (PDT), (Group 1, N = 11), PDT and intravitreal triamcinolone acetonide (4 mg/0.1ml) (Group 2, N = 3), PDT and intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab 1.25 mg/0.05 ml, ranibizumab 0.5 mg/0.05 ml and reduced-fluence PDT and intravitreal ranibizumab 0.5 mg/0.05 ml (Group 3, N=12). All the patients underwent PDT. Intravitreal injections were repeated as required. SPSS 14 software was used to evaluate the data. Wilcoxon signed ranks test was used to evaluate pre- and post-treatment vision. The Kruskal-Wallis test was used for comparison between the groups. All the groups were statistically comparable. All the eyes showed complete regression of CNV, with a minimum follow-up of six months. All groups had visual improvement; significantly in Group 3 (P = 0.003). Combination PDT with anti-VEGF agents appeared to be efficacious in eyes with myopic CNV. However, a larger study with a longer follow-up is required to validate these results.

Changing paradigms of anti-VEGF in the Indian scenario

“…Publications by Indian based authors on anti-VEGF agents started in the year 2007, with 69 peer reviewed papers published until September 2013. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 ] The years between 2007-10, being populated largely by case reports and occasional case series detailing the use of anti-VEGF agents in treating CNVM of other etiology, and retinopathy of prematurity[ 41 ] (2007), AMD[ 3 ] and adjunct to trabeculectomy[ 44 ] (2008). We can see a trend towards randomized case-control studies comparing different anti-VEGF agents, the use of combination treatments in AMD and other diseases si...…”

“…Case reports documenting the use of bevacizumab, ranibizumab and combination treatments such as anti-VEGF agents with photodynamic therapy have been published from India for the following indications:[ 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ]…”

“…A prospective and one retrospective case series documenting the use of anti-VEGF monotherapy or in combination with photodynamic therapy in the treatment of pathologic myopia and a retrospective case series documenting anti-VEGF to treat choroidal neovascularization associated with parafoveal telangiectasia have been published. [ 22 23 24 25 26 27 28 29 30 ] In a noncomparative, consecutive, interventional case series, Mandal et al showed that intravitreal bevacizumab resulted in > 3 line vision improvement in 75% of patients with myopic CNVM. [ 27 ] A retrospective comparison between PDT alone vs. PDT + triamcinolone vs. reduced fluence PDT + ranibizumab/bevacizumab to treat myopic CNVM showed visual improvement in all groups at 6 months, particularly in those treated with combination of PDT + anti-VEGF.…”

Low-fluence photodynamic therapy for early onset choroidal neovascular membrane following laser in situ keratomileusis

“…[2] Intravitreal injections of anti-vascular endothelial growth factor (VEGF) have also been shown to be effective therapeutic options. [3]…”

Myope CNV

“…[30,31]. Experimentelle Pilotstudien mit multiplen Wirkstoffkombinationen erscheinen vor diesem Hintergrund auch relativ fragwürdig [32,33]. Die PDT hat angesichts der funktionellen Ergebnisse und strukturellen Veränderungen nach den aktuellen Empfehlungen der Fachgesellschaft lediglich den Stellenwert einer Alternativ-oder Reserve-Therapie [34,35].…”