Triple Therapy for Choroidal Neovascularization Due to Age-Related Macular Degeneration

Abstract

Purpose:To evaluate the efficacy and safety of triple therapy with verteporfin photodynamic therapy (PDT), dexamethasone, and bevacizumab in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).Methods: This prospective, noncomparative, interventional case series included 104 patients. Verteporfin PDT was administered with a reduced light dose (42 J/cm 2 , accomplished by light delivery time of 70 seconds). Approximately 16 hours after PDT, dexamethasone (800 g) and bevacizumab (1.5 mg) were injected intravitreally. Patients attended follow-up visits every 6 weeks, undergoing visual acuity and intraocular pressure measurement, slit-lamp and ophthalmoscopic examination, and optical coherence tomography (OCT). Fluorescein angiography was performed every 3 months or earlier if OCT showed significant edema.Results: All 104 patients received one triple therapy cycle (5 patients received a second triple treatment due to remaining CNV activity). The triple therapy was complemented in 18 patients (17.3%) by an additional intravitreal injection of bevacizumab. The mean follow-up period was 40 weeks (range, 22-60 weeks). Mean increase in visual acuity was 1.8 lines (P Ͻ 0.01). Mean decrease in retinal thickness was 182 m (P Ͻ 0.01). No serious adverse events have been observed. Conclusion:In most patients with CNV due to AMD, triple therapy results in significant and sustained visual acuity improvement after only one cycle of treatment. In addition, the therapy offers a good safety profile, potentially lower cost compared with therapies that must be administered more frequently, and convenience for patients.RETINA 27:133-140, 2007 A s new therapies have become available to treat patients with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD), it is clear that no single therapy addresses the multifactorial pathogenesis of the disease. CNV progresses from age-related changes in the retina and supporting tissues. With age, the cells of the retinal pigment epithelium (RPE) are less able to detoxify, and cellular debris (drusen) accumulates between Bruch membrane and the RPE. 1,2 As Bruch membrane and the adjacent choriocapillaris age, they become brittle, reducing the size of the choroidal capillaries, and in turn affect metabolic activity and lead to hypoxia. [1][2][3] This choroidal vascular atrophy with the associated inflammatory response is thought to be the principal cause of dry AMD development. 2,3 Immunologic signals associated with acute vascular compromise may lead to

Intravitreal bevacizumab (Avastin) for primary treatment of diabetic macular oedema

“…20,26,27 The safety of intravitreal bevacizumab has been confirmed by previous animal studies and human trials, 28,29 and intravitreal injection of bevacizumab has recently been reported to be effective in macular oedema of various etiologies. 20,[30][31][32][33] Results of our study suggest that intravitreal bevacizumab injection appears to be effective in the primary treatment of DME. In our study, 24 eyes showed an improvement in VA with a decrease in fluorescein leakage on FFA (Figure 1a and b).…”

Photodynamic therapy combined with posterior subtenon triamcinolone acetonide injection in the treatment of choroidal neovascularization

“…[40][41][42] In particular, recent studies have shown that repeated monotherapy with anti-VEGF ranibizumab or bevacizumab may improve vision in patients with CNV of all types. [43][44][45] Sakaguchi et al 46 performed intravitreal bevacizumab (1 mg) injection to treat eight eyes with myopic CNV and improvement of BCVA to two or more lines was found in six eyes (75%).…”

Relationships between clinical measures of visual function and anatomic changes associated with bevacizumab treatment for choroidal neovascularization in age-related macular degeneration

“…[4][5][6] Moutray et al, 7 in a crosssectional study, observed significant correlation between distance VA and near-word acuity with angiographic parameters such as CNV diameter and area, and leakage area.…”