Triple therapy for neovascular age-related macular degeneration using single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone

Autor: Hoi Yau Tang, Chai Fong Woo, Pui Pui Yip, Chi Kin Ho
Rok vydání: 2009
Předmět:
Male
Intraocular pressure
Visual acuity
Triamcinolone acetonide
genetic structures
Anti-Inflammatory Agents
Visual Acuity
Angiogenesis Inhibitors
Triamcinolone
Macular Degeneration
Endophthalmitis
Fluorescein Angiography
Aged
80 and over
medicine.diagnostic_test
Antibodies
Monoclonal
Middle Aged
Clinical Science
Fluorescein angiography
Sensory Systems
Bevacizumab
Treatment Outcome
Choroidal neovascularization
Drug Therapy
Combination
Female
medicine.symptom
medicine.drug
medicine.medical_specialty
Antibodies
Monoclonal
Humanized
Injections
Cellular and Molecular Neuroscience
Ophthalmology
medicine
Humans
Glucocorticoids
Aged
business.industry
Original Articles
Macular degeneration
medicine.disease
Choroidal Neovascularization
eye diseases
Surgery
Vitreous Body
Photochemotherapy
sense organs
business
Follow-Up Studies
Zdroj: The British Journal of Ophthalmology
ISSN: 0007-1161
DOI: 10.1136/bjo.2008.150987
Popis: 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.
Databáze: OpenAIRE
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