Triple therapy for neovascular age-related macular degeneration using single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone
Open Access
- 8 March 2009
- journal article
- research article
- Published by BMJ in British Journal of Ophthalmology
- Vol. 93 (6), 754-758
- https://doi.org/10.1136/bjo.2008.150987
Abstract
Aim: To evaluate the efficacy and safety of triple therapy consisting single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVTA) for treatment of neovascular age-related macular degeneration (AMD) Methods: Consecutive patients with subfoveal choroidal neovascularisation (CNV) secondary to AMD were treated with PDT using a standard protocol immediately followed by 1.25 mg of IVB and 4 mg of IVTA. 1.25 mg of IVB was given at 3 months for residual leakage. Best-corrected Snellen visual acuity (BCVA) and fluorescein angiography (FA) were performed prior to treatment. BCVA, intraocular pressure (IOP) and presence of vitritis were documented at 1 and 6 weeks, 3 and 6 months. FA was repeated at 3 and 6 months. Outcome measures included visual improvement measured by logMAR equivalent, angiographic evident of leakage and safety profile. Results: 36 eyes of 33 patients, aged 76.4 (SD 10.5) years with mean follow-up of 14.7 (6.9–19.2) months were analysed. Baseline logMAR acuity was 1.22 (0.71). The mean logMAR acuity was 1.14 (0.62) and 1.18 (0.63) at 3 and 6 months respectively. At 6 months, 61.1% (22/36) showed stable or gaining vision, and 27.8% (10/36) gained three or more lines. Twenty-eight eyes (77.8%) achieved CNV resolution by single session of triple therapy. One eye lost more than six lines due to retinal pigment epithelium rip, three eyes showed a significant cataract requiring surgery, and two showed persistent raised IOP at 6 months. None resulted in endophthalmitis or reported thromboembolic event. Conclusions: Short-term results of single session triple therapy suggested that it might be a useful treatment option for neovascular AMD based on its low retreatment rates, sustainable CNV eradication result and visual gain achievement. However, the risk and benefits of using intravitreal triamcinolone in addition to combined PDT and IVB warrant further evaluation.Keywords
This publication has 26 references indexed in Scilit:
- Verteporfin Therapy and Intravitreal Bevacizumab Combined and Alone in Choroidal Neovascularization due to Age-Related Macular DegenerationOphthalmology, 2007
- Single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degenerationBMC Ophthalmology, 2007
- Ranibizumab for Neovascular Age-Related Macular DegenerationNew England Journal of Medicine, 2006
- Triamcinolone acetonide suppresses early proangiogenic response in retinal pigment epithelial cells after photodynamic therapy in vitroBritish Journal of Ophthalmology, 2006
- Verteporfin and Intravitreal Triamcinolone Acetonide Combination Therapy for Occult Choroidal Neovascularization in Age-Related Macular DegenerationAmerican Journal of Ophthalmology, 2006
- Intraocular pressure alterations following intravitreal triamcinolone acetonideBritish Journal of Ophthalmology, 2006
- Verteporfin Therapy Combined with Intravitreal Triamcinolone in All Types of Choroidal Neovascularization due to Age-Related Macular DegenerationOphthalmology, 2006
- Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancerNature Reviews Drug Discovery, 2004
- Problems with and pitfalls of photodynamic therapyOphthalmology, 2000
- Verteporfin photodynamic therapy retreatment of normal retina and choroid in the cynomolgus monkeyOphthalmology, 1999