1
|
INTRAVITREAL ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR FOR THE TREATMENT OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO OCULAR HISTOPLASMOSIS: Ten-Year Follow-Up. Retina 2022; 42:1568-1573. [PMID: 35877968 DOI: 10.1097/iae.0000000000003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To assess the long-term efficacy of intravitreal antivascular endothelial growth factor injections (IVI), alone or in combination with verteporfin photodynamic therapy (IVI/PDT), for management of choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome (POHS). METHODS Retrospective, comparative, interventional case series analyzing 82 eyes in 74 patients treated with either IVI or IVI/PDT for presumed ocular histoplasmosis syndrome choroidal neovascularization from January 2006 to January 2021. RESULTS The average logarithm of the minimum angle of resolution VA in year 5 was 0.40 (20/50) and 0.52 (20/67) for IVI versus IVI/PDT groups, respectively ( P = 0.33), and in year 10 was 0.53 (20/58) and 0.64 (20/86), respectively ( P = 0.50). The average number of annual injections over the first 5 years of follow-up was 3.3 versus 1.7 for IVI versus IVI/PDT groups, respectively ( P < 0.001), and over 10 years was 3.3 versus 1.6, respectively ( P < 0.001). Treatment-free interval of 5 years was reached by 39% versus 60% in IVI versus IVI/PDT groups, respectively ( P = 0.95). CONCLUSION Our study found both IVI and IVI/PDT to be effective in long-term management of presumed ocular histoplasmosis syndrome choroidal neovascularization, with a fewer number of annual injections and longer treatment-free interval in the combination group. However, given the limitations of a retrospective study, a prospective randomized study is necessary to determine whether the addition of PDT significantly decreases treatment burden.
Collapse
|
2
|
Khalil M, Hashmi U, Riaz R, Rukh Abbas S. Chitosan coated liposomes (CCL) containing triamcinolone acetonide for sustained delivery: A potential topical treatment for posterior segment diseases. Int J Biol Macromol 2020; 143:483-491. [DOI: 10.1016/j.ijbiomac.2019.10.256] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
|
3
|
Agarwal A, Rhoades WR, Hanout M, Soliman MK, Sarwar S, Sadiq MA, Sepah YJ, Do DV, Nguyen QD. Management of neovascular age-related macular degeneration: current state-of-the-art care for optimizing visual outcomes and therapies in development. Clin Ophthalmol 2015; 9:1001-15. [PMID: 26089632 PMCID: PMC4467654 DOI: 10.2147/opth.s74959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Contemporary management of neovascular age-related macular degeneration (AMD) has evolved significantly over the last few years. The goal of treatment is shifting from merely salvaging vision to maintaining a high quality of life. There have been significant breakthroughs in the identification of viable drug targets and gene therapies. Imaging tools with near-histological precision have enhanced our knowledge about pathophysiological mechanisms that play a role in vision loss due to AMD. Visual, social, and vocational rehabilitation are all important treatment goals. In this review, evidence from landmark clinical trials is summarized to elucidate the optimum modern-day management of neovascular AMD. Therapeutic strategies currently under development, such as gene therapy and personalized medicine, are also described.
Collapse
Affiliation(s)
- Aniruddha Agarwal
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - William R Rhoades
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mostafa Hanout
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohamed Kamel Soliman
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Salman Sarwar
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mohammad Ali Sadiq
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yasir Jamal Sepah
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana V Do
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| |
Collapse
|
4
|
HAN DONGMEI, YAO YUAN, SUN YONG, GONG YUANYUAN, WU XINGWEI. Effect of charred Radix et Rhizoma Rhei in a laser-induced choroidal neovascularization murine model. Mol Med Rep 2014; 11:2896-902. [DOI: 10.3892/mmr.2014.3046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 11/04/2014] [Indexed: 11/05/2022] Open
|
5
|
Chen SN, Lin CJ, Li KH, Hwang JF. Choroidal infarction after photodynamic therapy combined with bevacizumab and triamcinolone reversed by tissue plasminogen activator: case report. Retin Cases Brief Rep 2013; 7:52-56. [PMID: 25390522 DOI: 10.1097/icb.0b013e318263d3d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To present a case of choroidal infarction after combined therapy of photodynamic therapy, intravitreal bevacizumab, and sub-Tenon triamcinolone injection salvaged by tissue plasminogen activator administration. METHODS Interventional case report. RESULTS Combined therapy of full-fluence photodynamic therapy, intravitreal bevacizumab, and sub-Tenon triamcinolone injection was given on the same day to treat neovascular age-related macular degeneration in an 82-year-old patient. Subsequent acute visual loss and marked macular edema as a result of choroidal infarction were noted. Intravitreal and sub-Tenon administration of tissue plasminogen activator were performed 9 days later to salvage the choroidal infarction, and visual improvement was noted. Fundoscopy and optical coherent tomography showed almost complete resolution of macular edema. Indocyanine green angiography revealed reperfusion of the choroidal vessels. CONCLUSION Choroidal infarction may happen after combined therapy. Tissue plasminogen activator administration may reverse the infarction and help visual recovery.
Collapse
Affiliation(s)
- San-Ni Chen
- *Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan †School of Medicine, Chung Shan Medical University, Taichung, Taiwan ‡Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | | | | | | |
Collapse
|
6
|
Cionni DA, Lewis SA, Petersen MR, Foster RE, Riemann CD, Sisk RA, Hutchins RK, Miller DM. Analysis of Outcomes for Intravitreal Bevacizumab in the Treatment of Choroidal Neovascularization Secondary to Ocular Histoplasmosis. Ophthalmology 2012; 119:327-32. [DOI: 10.1016/j.ophtha.2011.08.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 07/24/2011] [Accepted: 08/19/2011] [Indexed: 11/30/2022] Open
|
7
|
Abstract
While angiogenesis is one of the factors associated with the development of CNV due to age-related macular degeneration (AMD), inflammation and oxidative stress also appear to play a role. Treatment of CNV with intravitreal anti-vascular endothelial growth factor monotherapy is currently the standard of care. However, not all patients respond to monotherapy, and combination therapy may target the CNV through multiple mechanisms, thus reducing treatment frequency or improving visual outcome. Photodynamic therapy (with regular or reduced fluence), as well as intravitreal steroids are used in combination with anti-VEGF therapy. This paper reviews the many clinical trials that have been performed utilizing several combinations of double and triple therapy. While combination therapy is biologically justifiable, further study is required to determine correct combinations and dosage.
Collapse
Affiliation(s)
- Steven M Couch
- Mayo Clinic, Department of Ophthalmology, Rochester, MN 55905, USA
| | | |
Collapse
|
8
|
Spitzer MS, Ziemssen F, Bartz-Schmidt KU, Gelisken F, Szurman P. Treatment of age-related macular degeneration: focus on ranibizumab. Clin Ophthalmol 2011; 2:1-14. [PMID: 19668384 PMCID: PMC2698673 DOI: 10.2147/opth.s1959] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Ranibizumab, a humanized antigen-binding fragment (Fab) that binds all isoforms of VEGF-A, significantly slows down loss of vision and causes significant visual improvement in many patients with choroidal neovascularization (CNV) due to exudative age-related macular degeneration (AMD). These benefits of intravitreal ranibizumab apply to all angiographic subtypes of neovascular AMD and across all lesion sizes when the drug is injected at monthly intervals as shown in two pivotal phase III trials (ANCHOR and MARINA). The results from the PrONTO study suggest that less frequent treatment with ranibizumab through a variable dosing regimen dependent on optical coherence tomography (OCT) findings is a treatment option that results in comparably favorable visual outcomes. Currently, it is unclear whether combination therapy of ranibizumab with photodynamic therapy (PDT) provides any significant advantage over ranibizumab monotherapy (FOCUS trial); however, the combination of PDT and ranibizumab may decrease the need for frequent retreatment. This question will be addressed in the SUMMIT trial. Therapy with ranibizumab is generally very well tolerated with a low rate of seriously adverse ocular events or systemic side-effects. The advent of vascular endothelial growth factor (VEGF) inhibitors has revolutionized the therapy of neovascular AMD. Ranibizumab at the moment appears to be the most effective approved treatment for neovascular AMD.
Collapse
Affiliation(s)
- Martin S Spitzer
- Tuebingen University Eye Center, University of Tuebingen, Germany
| | | | | | | | | |
Collapse
|
9
|
Veritti D, Sarao V, Lanzetta P. Update on combination therapy in wet age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Hollands H, Seif G, Hollands S, Gale J. A trial of topical prednisolone acetate before intravitreal triamcinolone acetonide decreases intraocular pressure spikes. Can J Ophthalmol 2010; 45:484-8. [DOI: 10.3129/i10-050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
11
|
Ansari-Shahrezaei S, Binder S, Stur M. The effect of laser unit on photodynamic therapy spot size. Graefes Arch Clin Exp Ophthalmol 2010; 249:11-4. [DOI: 10.1007/s00417-010-1460-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 11/25/2022] Open
|
12
|
Pece A, Russo G, Ricci F, Isola V, Introini U, Querques G. Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks. Clin Ophthalmol 2010; 4:525-30. [PMID: 20596507 PMCID: PMC2893762 DOI: 10.2147/opth.s10649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report the visual outcome of photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide (IVTA) for choroidal neovascularization (CNV) secondary to angioid streaks (AS). METHODS Five eyes of five consecutive patients (mean age 45 +/- 10 years) with CNV secondary to AS were treated by combination of PDT and IVTA. TA (4 mg/0.1 mL) was injected 7 days before PDT. RESULTS All patients completed the 12-month follow-up. CNV was subfoveal in three cases and extrafoveal in two. Median best-corrected visual acuity (BCVA) was 0.3 LogMAR (70 letters) at baseline (range 1.3-0.1), and 0.5 LogMAR (60 letters) at the final examination (range 1.0-0.1). At 12 months, one patient had severe visual deterioration, with a loss of seven lines of VA; Two patients lost up to three lines. One patient had no change in BCVA and the fifth gained nine lines of VA. Two patients received one further combination of PDT and IVTA after the first combination treatment. All eyes showed the CNV closure at the 12-month follow-up visit. CONCLUSIONS Combination of PDT and IVTA may reduce the need for retreatment and could be potentially useful for preserving vision in some patients with CNV due to AS.
Collapse
Affiliation(s)
- Alfredo Pece
- Department of Ophthalmology, Melegnano Hospital, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Yamada Y, Miyamura N, Suzuma K, Kitaoka T. Long-term follow-up of full macular translocation for choroidal neovascularization. Am J Ophthalmol 2010; 149:453-7.e1. [PMID: 20035923 DOI: 10.1016/j.ajo.2009.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 09/16/2009] [Accepted: 09/16/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the long-term (>5 years) results of full macular translocation in patients with choroidal neovascularization (CNV). DESIGN Retrospective, interventional case series. METHODS This study involved 32 eyes of 32 patients who had undergone full macular translocation for CNV. The median follow-up was 6.5 years (range, 5.2 to 7.7 years). We evaluated the best-corrected visual acuity, fundus examination results obtained before and 1 and 5 years after operation, and postoperative complications. RESULTS At the 1-year follow-up, foveal retinal pigment epithelium atrophy was observed in only 3 eyes (12%), and the mean logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) at that time (1.39 +/- 0.67) was not significantly changed from that before surgery (logMAR, 1.31 +/- 0.66) in 25 eyes with age-related macular degeneration (AMD). However, at 5-year follow-up, foveal retinal pigment epithelium atrophy increased (18 eyes; 72%), and final mean logMAR VA (1.88 +/- 0.76) was significantly lower (P < .01). Five eyes with myopic CNV maintained their VA from before operation (mean logMAR, 0.88 +/- 0.35) until final follow-up (mean logMAR, 0.73 +/- 0.31). The final VA was significantly better in myopic CNV than in exudative age-related macular degeneration on multiple regression analysis (P = .019). CONCLUSIONS Long-term follow-up of full macular translocation showed that the final VA was poor in age-related macular degeneration, but relatively better in myopic CNV.
Collapse
|
14
|
Lie S, Aue A, Sacu S, Simader C, Polak K, Schmidt-Erfurth U. Time-course and characteristic morphology of retinal changes following combination of verteporfin therapy and intravitreal triamcinolone in neovascular age-related macular degeneration. Acta Ophthalmol 2010; 88:212-7. [PMID: 19016662 DOI: 10.1111/j.1755-3768.2008.01405.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify characteristic morphological changes of the retina over time and the association with visual function after combined photodynamic therapy (PDT) and intravitreal triamcinolone (IVTA). METHODS In this retrospective study, 40 patients (40 eyes) were treated with PDT and same-day IVTA. Optical coherence tomography (OCT), fluorescein angiography (FA) and evaluation of distance visual acuity (VA) were performed. The anatomical changes within intra- and subretinal compartments and their detailed analysis and grading were the main outcome measures. RESULTS Intraretinal fluid (IRF) and subretinal fluid (SRF) by OCT decreased until 3 months (p < 0.01). At month 3, intraretinal cystoid spaces (ICS) had resolved or decreased in 84% of eyes, SRF in 58% and pigment epithelial detachment (PED) in 50%. Mean best-corrected VA (BCVA) improved significantly at month 1 (p < 0.01). Mean central retinal thickness (CRT) increased from 334 microm at baseline to 439 microm at day 1 (p = 0.03) before decreasing to 286 microm at day 7 (p = 0.06), 233 microm at month 1 (p = 0.001) and 255 microm at month 3 (p = 0.001). CONCLUSION Combined verteporfin/IVTA therapy induces distinct time-related effects on the retina within the different intra- and subretinal compartments.
Collapse
Affiliation(s)
- Shilla Lie
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
15
|
Chan A, Blumenkranz MS, Wu KHC, Wang G, Berker N, Parast LM, Sanislo SR. Photodynamic therapy with and without adjunctive intravitreal triamcinolone acetonide: a retrospective comparative study. Ophthalmic Surg Lasers Imaging Retina 2010; 40:561-9. [PMID: 19928721 DOI: 10.3928/15428877-20091030-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration. PATIENTS AND METHODS Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events. RESULTS Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [P = .0049], 6 [P = .003], and 12 [P = .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (P = .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups. CONCLUSION PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.
Collapse
Affiliation(s)
- Annie Chan
- Department of Ophthalmology, Stanford University Medical Center, Stanford University, Menlo Park, CA 94025, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
RETROSPECTIVE REVIEW OF THE EFFICACY OF TOPICAL BROMFENAC (0.09%) AS AN ADJUNCTIVE THERAPY FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2009; 29:1527-31. [DOI: 10.1097/iae.0b013e3181b32f4c] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Effect of combined treatment with sub-Tenon injection of triamcinolone acetonide and photodynamic therapy in Japanese patients with age-related macular degeneration. Jpn J Ophthalmol 2009; 53:512-8. [DOI: 10.1007/s10384-009-0703-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
|
18
|
Ranchod TM, Brucker AJ, Liu C, Cukras CA, Hopkins TB, Ying GS. Evaluation of actual vs expected photodynamic therapy spot size. Am J Ophthalmol 2009; 147:859-64, 864.e1. [PMID: 19195634 DOI: 10.1016/j.ajo.2008.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 11/10/2008] [Accepted: 11/14/2008] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the accuracy of the photodynamic therapy (PDT) laser spot size on the retina as generated by 2 Food and Drug Administration (FDA)-approved lasers. DESIGN Prospective observational case series. METHODS Fundus photographs were taken of 1 eye of each of 10 subjects with the WinStation 4000 fundus photography system (OIS; Ophthalmic Imaging Systems, Sacramento, California, USA); disc size was calculated using OIS software. Slit-lamp photographs were taken of the PDT laser spot focused on the retina adjacent to the optic disc, using various spot sizes in combination with 3 different contact lenses and 2 different lasers. Spot size at the retina was determined by measuring the ratio of disc diameter to spot diameter in Adobe Photoshop (San Jose, California, USA) and applying this ratio to the OIS disc measurements. RESULTS Spot size at the retina averaged 87% of expected spot size for the Coherent Opal laser (Coherent Inc, Santa Clara, California, USA) and 104% of expected spot size for the Zeiss Visulas laser (Carl Zeiss Meditec Inc, Dublin, California, USA)(P = .002). Multivariate analysis demonstrated that percentage of expected spot size decreased with larger spot diameter (P = .01 for Coherent laser; P = .02 for Zeiss laser). CONCLUSIONS PDT spot size at the retina appears to be consistently smaller than expected for the Coherent laser while the spot size was consistently within 10% of expected size for the Zeiss laser. The deviation from expected size increased with larger spot size using the Coherent laser.
Collapse
|
19
|
Roth DB, Kulkarni KM, Walsman S, Modi A. Intravitreal Triamcinolone Acetonide Preceding Photodynamic Therapy for Exudative Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2009; 40:467-71. [DOI: 10.3928/15428877-20090901-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2008] [Indexed: 11/20/2022]
|
20
|
Rosenfeld PJ, Martidis A, Tennant MT. Age-Related Macular Degeneration. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
21
|
Choroidal Neovascularization. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
22
|
Stur M. Indikationen für photodynamische Therapie mit Verteporfin im Zeitalter der intravitrealen Therapie – eine Übersicht. SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
23
|
Pieramici DJ, Rabena M, Castellarin AA, Nasir M, See R, Norton T, Sanchez A, Risard S, Avery RL. Ranibizumab for the treatment of macular edema associated with perfused central retinal vein occlusions. Ophthalmology 2008; 115:e47-54. [PMID: 18708258 DOI: 10.1016/j.ophtha.2008.06.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 06/14/2008] [Accepted: 06/18/2008] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Assessment of biological effect, visual acuity changes, and safety of intravitreal (IVT) ranibizumab in patients with macular edema associated with perfused central retinal vein occlusion (CRVO). DESIGN Ongoing, prospective, open-label, single-center, uncontrolled study. PARTICIPANTS Ten adult patients with macular edema associated with perfused CRVO. METHODS Patients were randomly assigned to receive 3 monthly IVT injections of either 0.3 or 0.5 mg ranibizumab (n = 5 at each dose). Additional injections were administered quarterly as needed over the ensuing 21 months at the physician's discretion for recurrent or persistent macular edema. MAIN OUTCOME MEASURES The predetermined primary endpoint was the percentage of patients gaining >or=15 letters of best-corrected Early Treatment of Diabetic Retinopathy Study visual acuity (BCVA). The secondary endpoints include the mean change in BCVA and central retinal thickness (CRT) measured by optical coherence tomography, the rate of progression to ischemic CRVO, extent of intraocular hemorrhage, retinal vein diameter, optic nerve head swelling, and the incidence and severity of ocular and nonocular adverse events. RESULTS After 3, 6, and 9 months of follow-up, 40%, 10%, and 30% of patients, respectively, gained >or=15 letters in BCVA; mean BCVA improved by 12+/-20 letters, 3+/-21 letters, and 1+/-24 letters, respectively, compared with baseline; CRT showed a mean decrease of 272+/-244 microm, 88+/-178 microm, and 119+/-153 microm, compared with baseline. No significant differences were observed between the 0.3- and 0.5-mg doses. Most patients experienced decreases in the extent of retinal hemorrhage, retinal vein diameter, and optic nerve head swelling at months 3 and 6 compared with baseline. No patients progressed to ischemic CRVO or experienced a severe adverse event that was attributed to ranibizumab. CONCLUSIONS Ranibizumab is generally well-tolerated and may improve BCVA and decrease CRT. The improvements in BCVA and CRT observed during the initial monthly injection period (0 to 3 months) were possibly lost to the recurrence of macular edema in between ranibizumab injection during the quarterly treatments (3 to 9 months). The extent of retinal hemorrhage, retinal vein diameter, and nerve swelling continued to normalize for most of the patients from baseline to 6 months. Follow-up is ongoing, and alternative dosing regimens are being evaluated.
Collapse
Affiliation(s)
- Dante J Pieramici
- California Retina Consultants and Research Foundation, Santa Barbara, California 93103, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Effect of aspirin therapy on photodynamic therapy with verteporfin for choroidal neovascularization. Retina 2008; 28:711-6. [PMID: 18463514 DOI: 10.1097/iae.0b013e31816079c3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) with verteporfin is used for treatment of choroidal neovascularization in several conditions. Platelet aggregation is one of the mechanisms by which PDT is thought to work. This study sought to examine the hypothesis that systemic use of aspirin, an inhibitor of platelet aggregation, affects the efficacy of PDT. METHODS A retrospective review was conducted of data for patients treated with PDT at one institution between 2001 and 2004. End points included total number of PDT treatments, mean time between PDT treatments, change in visual acuity from baseline to 3 months after last PDT treatment, and concurrent or subsequent treatments other than PDT. RESULTS A total of 244 eyes of 222 patients met inclusion criteria, of which 102 eyes from 92 patients were included in the aspirin taking group. Aspirin takers received an average of 3.11 PDT treatments compared with 2.39 PDT treatments for nonaspirin takers (P = 0.001). Decrease in logMAR visual acuity was greater for aspirin takers (P = 0.0003), and a loss of > or =3 lines was seen in 58% of aspirin takers compared with 35% of nonaspirin takers (P = 0.0003). These differences remained statistically significant after controlling for patient age, lesion type, and lesion size. CONCLUSIONS Patients taking aspirin required more PDT treatments and had worse visual outcomes than patients not taking aspirin, possibly due to aspirin's ability to inhibit platelet aggregation and thereby diminish the efficacy of PDT.
Collapse
|
25
|
Abd-El-Barr MM, Albini TA, Carvounis PE, He F, Manzano RPA, Chevez-Barrios P, Wensel TG, Wu SM, Holz ER. Safety and pharmokinetics of triamcinolone hexacetonide in rabbit eyes. J Ocul Pharmacol Ther 2008; 24:197-205. [PMID: 18355133 DOI: 10.1089/jop.2007.0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate whether intravitreal triamcinolone hexacetonide (TH) is a safe, longer lasting alternative to intravitreal triamcinolone acetonide (TA) in the rabbit eye. METHODS Three groups, each comprising of 15 Dutch-belted rabbits, received a unilateral injection of 0.1 mL of drug and 0.1 mL of physiologic salt solution in the fellow eye. Group I received TA, group II received commercially available TH, and group III received reformulated iso-osmolar triamcinolone hexacetonide (rTH). Simultaneous bilateral dark-adapted electroretinography was performed following the injection. Retinal morphology was assessed by using histopathology in each group enucleated 12 weeks after injection. High-performance liquid chromatography of vitreous isolated from the enucleated eyes was used to determine drug concentrations. RESULTS A significant reduction in saturated a-wave and maximal scotopic b-wave was observed in the group II eyes relative to the fellow control eyes at both 2 and 12 weeks postinjection (P < 0.001 for each comparison) but not in the other groups. Histopathology showed no differences between drug-injected eyes and fellow control eyes in groups I and III, but in group II there was severe degeneration of all retina layers. In group I, the drug half-life was 17.7 +/- 1.7 days, group II 44 +/- 13 days, and group III 12.8 +/- 2.3 days. CONCLUSIONS The half-life of commercially available TH in the vitreous is double that of TA, but the former is toxic to the retina in this rabbit model. Reformulated iso-osmolar TH showed no evidence of deleterious effects to retina function or structure but had a similar half-life to TA.
Collapse
Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Seitsonen SP, Jarvela IE, Meri S, Tommila PV, Ranta PH, Immonen IJ. The effect of complement factor H Y402H polymorphism on the outcome of photodynamic therapy in age-related macular degeneration. Eur J Ophthalmol 2008; 17:943-9. [PMID: 18050121 DOI: 10.1177/112067210701700612] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Photodynamic therapy (PDT) has been widely used in the treatment of age-related macular degeneration (AMD). The complement cascade has an important role in the tissue reactions occurring after PDT. The Y402H polymorphism of the complement factor H (CFH) gene has been identified as a risk factor for AMD. Since CFH is central in the regulation of the complement system the authors wanted to analyze whether the CFH Y402H polymorphism modifies the PDT outcome in AMD. METHODS A total of 88 patients having been treated with PDT and without further scheduled PDT sessions were analyzed. Depending on the situation at their final PDT session the patients were classified retrospectively as PDT-responders or PDT-nonresponders. All patients were genotyped for the CFH Y402H polymorphism. RESULTS The proportion of PDT-responders was 18/26 (69.2%) in patients homozygous for the CFH Y402H risk allele, 34/50 (68.0%) in heterozygous, and 7/12 (58.3%) in patients with the normal genotype (p=0.520). The median number of PDT treatments of the PDT-responders was three for all the genotypes. CONCLUSIONS The dysfunction of the CFH related to the risk of AMD and caused by the Y402H polymorphism does not modify the outcome of PDT. Genotyping for CFH Y402H cannot be used to select patients for this treatment.
Collapse
Affiliation(s)
- S P Seitsonen
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Lee YA, Ho TC, Chen MS, Yang CH, Yang CM. Photodynamic therapy combined with posterior subtenon triamcinolone acetonide injection in the treatment of choroidal neovascularization. Eye (Lond) 2008; 23:645-51. [DOI: 10.1038/eye.2008.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
29
|
Roth DB, Kulkarni KM, Feuer WJ. The temporal sequence of combined intravitreal triamcinolone acetonide and photodynamic therapy for exudative age-related macular degeneration. Ophthalmic Surg Lasers Imaging Retina 2008; 39:12-6. [PMID: 18254345 DOI: 10.3928/15428877-20080101-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare visual acuity results in patients with exudative age-related macular degeneration treated with two different temporal sequences of combination intravitreal triamcinolone acetonide and photodynamic therapy with verteporfin. PATIENTS AND METHODS A retrospective, comparative, interventional case series was used. Thirty-one eyes received intravitreal triamcinolone acetonide 1 week prior to photodynamic therapy, and 30 eyes received intravitreal triamcinolone acetonide followed by photodynamic therapy the same day. RESULTS There was no significant difference in visual acuity between the groups at baseline (P = .084), 6 to 12 weeks of follow-up (P = .085), or 1 year of follow-up (P= .093). When visual acuity outcomes were adjusted for baseline visual acuity, spot size, lesion type, age, and gender, there was no significant difference in visual acuity at 6 to 12 weeks (P = .44) or 1 year (P= .28). CONCLUSIONS There appears to be no significant difference in visual outcomes in eyes with exudative age-related macular degeneration treated with intravitreal triamcinolone acetonide 1 week prior to photodynamic therapy or those treated with intravitreal triamcinolone acetonide on the same day as photodynamic therapy.
Collapse
Affiliation(s)
- Daniel B Roth
- Retina Vitreous Center, Department of Ophthalmology, Robert Wood Johnson Medical School, University of Medicine & Dentistry of New Jersey, New Brunswick 08901-1977, USA
| | | | | |
Collapse
|
30
|
12-MONTH RETROSPECTIVE STUDY AND REVIEW OF PHOTODYNAMIC THERAPY WITH VERTEPORFIN FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION. Retina 2008; 28:289-97. [DOI: 10.1097/iae.0b013e31813ffe90] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Gopal L, Sharma T. Use of intravitreal injection of triamcinolone acetonide in the treatment of age-related macular degeneration. Indian J Ophthalmol 2007; 55:431-5. [PMID: 17951899 PMCID: PMC2635983 DOI: 10.4103/0301-4738.36477] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Age-related macular degeneration (AMD) is now considered an important and leading cause of blindness among elderly patients in developed and developing countries. AMD has two forms, dry and wet; both can lead to visual loss. However, occurrence of subfoveal choroidal neovascular (CNV) membrane in the wet form results in severe visual impairment. Treatment options for choroidal neovascularization are available in order to maintain and in some cases improve vision. Photodynamic therapy (PDT) has been used to treat both classic and occult membranes. It has known to cause choroidal hypoperfusion and production of vascular endothelial growth factor. Intravitreal steroid can possibly reduce the damage caused due to these undesirable effects. In the recent past, intravitreal injection of triamcinolone acetonide (IVTA) has been used extensively as an adjunct to PDT in AMD in order to reduce the number of PDT sessions and evaluate possible beneficial effects on vision. This article reviews the pharmacological attributes of triamcinolone, available evidence of its use as monotherapy or combination therapy to treat AMD, ocular side-effects thereof and ongoing clinical trials on IVTA.
Collapse
Affiliation(s)
- Lekha Gopal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, 18 College Road, Chennai - 600 006, India.
| | | |
Collapse
|
32
|
Gamulescu MA, Helbig H. A new era in the treatment of age-related macular degeneration: from Factor X to antiangiogenesis. Expert Opin Ther Pat 2007. [DOI: 10.1517/13543776.17.11.1351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
33
|
Schmidt-Erfurth UM, Richard G, Augustin A, Aylward WG, Bandello F, Corcòstegui B, Cunha-Vaz J, Gaudric A, Leys A, Schlingemann RO. Guidance for the treatment of neovascular age-related macular degeneration. ACTA ACUST UNITED AC 2007; 85:486-94. [PMID: 17655610 DOI: 10.1111/j.1600-0420.2007.00979.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neovascular age-related macular degeneration is becoming an increasing socio-medical problem as the proportion of the aged population is continuously increasing. However, new insights in the pathogenesis of the disease offer the opportunity to develop targeted therapies that attack the disease process more successfully than ever. This review article will focus on summarizing the actual options in the management of neovascular age-related macular degeneration and provide a short overview about recent therapeutic options in clinical and preclinical evaluation. The recent development of anti-VEGF substances for use in clinical routine has markedly improved the prognosis of patients with neovascular AMD. Intravitreal treatment with substances targeting all isotypes of vascular endothelial growth factor (VEGF), for the first time in the history of AMD treatments, results in a significant increase in visual acuity in patients with neovascular AMD. Overall, antiangiogenic approaches provide vision maintenance in over 90% and substantial improvement in 25-40% of patients. The combination with occlusive therapies like photodynamic therapy (PDT) potentially offers a reduction of re-treatment frequency and long-term maintenance of the treatment benefit. Further developments interacting with various steps in the angiogenic cascade are under clinical or preclinical evaluation and may soon become available. Nevertheless, the growing number of novel therapeutic options will have to provide proof of concept in randomized controlled clinical trials, a major challenge in view of the rapidly evolving field. For those therapies, which are already in clinical use, reasonable diagnostic tools for follow-up need to be developed, as the burden of continuous clinical monitoring of all patients and all indications is significant for patients and doctors. Ultimately, economic issues will be the limiting factor for the clinical availability of different treatment options.
Collapse
|
34
|
Iriyama A, Obata R, Inoue Y, Takahashi H, Tamaki Y, Yanagi Y. Effect of posterior juxtascleral triamcinolone acetonide on the efficacy and choriocapillaris hypoperfusion of photodynamic therapy. Graefes Arch Clin Exp Ophthalmol 2007; 246:339-44. [PMID: 17805556 DOI: 10.1007/s00417-007-0667-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 07/23/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the effect of posterior juxtascleral triamcinolone acetonide (TA) injection combined with photodynamic therapy with verteporfin (PDT) for treating exudative age-related macular degeneration (AMD), the best-corrected visual acuity (BCVA), the retreatment rates and the rate of choroidal hypoperfusion were investigated. METHODS A total of 67 eyes with subfoveal choroidal neovascularization (CNV) due to AMD were included. Forty-four eyes underwent PDT alone (PDT-alone group), and 23 eyes underwent PDT with the posterior juxtascleral injection of TA (PDT+TA group). Every 3 months after the PDT, the eyes were evaluated with regard to BCVA and requirement for retreatment by fluorescein angiography (FA) with the aid of optical coherence tomography (OCT). Choroiocapillaris hypoperfusion was assessed by indocyanine green angiography (ICGA) at 3 and 12 months. All patients completed a 1-year follow-up. RESULTS At the baseline, there was no difference in lesion type, size or visual acuity between the two groups. At 1 year, the change in BCVA was -0.0811 logarithm of the minimum angle of resolution (LogMAR) in the PDT-alone group, compared with -0.0432 logMAR in the PDT+TA group. There was no significant difference in the change in BCVA between the two groups (P = 0.6910). The PDT+TA group required a lower mean number of treatments (1.64 compared with 2.34 [P = 0.0223]) and showed a higher rate of choriocapillaris occlusion at 3 months, but no significant difference at 1 year (P = 0.9243) CONCLUSIONS Fewer retreatments were required in the TA+PDT group. There was no significant difference in the change in BCVA between the two groups. Adjacent TA may promote short-term choriocapillaris hypoperfusion.
Collapse
Affiliation(s)
- Aya Iriyama
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | | | | | | | | | | |
Collapse
|
35
|
Krebs I, Krepler K, Stolba U, Goll A, Binder S. Retinal angiomatous proliferation: combined therapy of intravitreal triamcinolone acetonide and PDT versus PDT alone. Graefes Arch Clin Exp Ophthalmol 2007; 246:237-43. [PMID: 17674018 DOI: 10.1007/s00417-007-0651-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 06/21/2007] [Accepted: 07/01/2007] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of the study was to investigate whether combined treatment with photodynamic therapy (PDT) and triamcinolone acetonide intravitreally applied is superior to PDT alone in eyes with retinal angiomatous proliferation (RAP). METHODS Between July 2004 and June 2005 eyes with RAP in age-related macular degeneration were included in a prospective study and were treated with 4 mg of triamcinolone acetonide followed by PDT (group 1). Eyes with RAP treated with PDT alone before June 2004 were retrospectively reviewed (group 2). Distance visual acuity (VA) with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, greatest diameter of the lesion (measured by fluorescein angiography), and retinal thickness (measured by optical coherence tomography) were performed at baseline and at 6 weeks, 3 months, 6 months and 12 months thereafter. RESULTS Fifty-eight eyes in 58 patients were included: 27 eyes in the combined treatment group and 31 eyes in the PDT monotherapy group. The groups were comparable with regard to age, gender and RAP stage. VA decreased from 65.6 to 52.0 and from 60.7 to 44.0 letters, and lesion size increased from 3.2 mm to 3.5 mm and from 3.3 mm to 3.5 mm in the combined and monotherapy groups respectively. There was a trend towards a better outcome in the combined group. Significantly (p = 0.01) fewer complications occurred in the combined group (22.2%) than in the monotherapy group (54.8%). CONCLUSION No significant differences could be found in the time course of distance VA, retinal thickness, and lesion size between the PDT monotherapy group and the combined PDT and IVTA group. However, significantly fewer complications occurred in the combined treatment group. New therapeutic strategies might be required in RAP lesions, probably including therapy with anti-angiogenic agents.
Collapse
Affiliation(s)
- Ilse Krebs
- Department of Ophthalmology, Ludwig Boltzmann Institute of Retinology and Biomicroscopic Laser Surgery, Rudolf Foundation Clinic, Juchgasse 25, Vienna, Austria.
| | | | | | | | | |
Collapse
|
36
|
Arias L, Garcia-Arumi J, Ramon JM, Badia M, Rubio M, Pujol O. Optical coherence tomography analysis of a randomized study combining photodynamic therapy with intravitreal triamcinolone. Graefes Arch Clin Exp Ophthalmol 2007; 246:245-54. [PMID: 17674020 DOI: 10.1007/s00417-007-0642-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2006] [Revised: 12/31/2006] [Accepted: 01/05/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of the study was to analyze optical coherence tomography (OCT) scan differences between patients with predominantly classic subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with only photodynamic therapy (PDT) and patients treated with PDT combined with intravitreal triamcinolone acetonide (IVTA). METHODS In this prospective study, 61 patients were randomized to receive PDT (n = 30) or PDT combined with IVTA (n = 31). They were evaluated every 3 months with a refraction protocol for best-corrected visual acuity (VA) measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, fluorescein angiography (FA), and OCT. When measuring foveal thickness on OCT scans, neuroretinal foveal thickness (NFT) was differentiated from outer high reflectivity band thickness (OHRBT). The main outcome measures were mean change in OCT measurements and correlation of VA and angiographic area of the lesion with OCT measurements. RESULTS At the 12-month follow-up, the mean change in NFT was not significantly reduced (P = 0.9), but the mean change in OHRBT was significantly lower (P = 0.004) in the group of patients who received combined therapy. There was no correlation between final VA and NFT in either patient group (P = 0.2). The final VA was significantly worse in eyes with a thicker OHRBT (P = 0.04) in the group of patients treated with only PDT. There was no correlation between angiographic area and NFT and OHRBT in either patient group (P > 0.3). There was a statistically significant difference between the pre-treatment angiographic area of the lesion and VA at the 12-month follow-up in the combined therapy group (P = 0.01), and more eyes treated with only PDT presented with intraretinal fluid at the last follow-up (P = 0.01). CONCLUSION Combined PDT+IVTA therapy was more effective than PDT alone at reducing OHRBT. This OCT measurement seems to be have a greater effect on VA than NFT.
Collapse
Affiliation(s)
- L Arias
- Department of Ophthalmology, Bellvitge University Hospital, C/Feixa Llarga, S/N L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
37
|
Schmidt-Erfurth UM, Richard G, Augustin A, Aylward WG, Bandello F, Corcòstegui B, Cunha-Vaz J, Gaudric A, Leys A, Schlingemann RO. Guidance for the treatment of neovascular age-related macular degeneration. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1755-3768.2007.00979.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
Abstract
PURPOSE To review proved and experimental treatments for exudative and nonexudative complications of age-related macular degeneration (AMD), to consider the impact of current therapy on the structure of future clinical trials, and to consider the role of improved diagnostic imaging techniques on the effectiveness of current therapy as well as the structure of future clinical trials in AMD patients. RESULTS Defining the cell biology of choroidal new vessel (CNV) formation and geographic atrophy will lead to identification of different biochemical pathways that are the target of AMD treatment. Many treatments and treatment combinations are under study for AMD, but all work through a finite number of pathways. Currently, the most effective proved therapy for AMD-associated CNVs is administered by repeated intravitreal injection of agents that inhibit vascular endothelial growth factor, e.g., ranibizumab. Improved drug delivery will enhance patient satisfaction and possibly will enhance the effectiveness and reduce the risk of current pharmacotherapy for AMD-associated CNVs. Combination therapy (e.g., verteporfin-photodynamic therapy + ranibizumab) appears to reduce the risk and enhance the effectiveness of CNV treatment compared with monotherapy with currently available agents. Improved noninvasive diagnostic imaging may lead to better visual outcomes with existing therapeutic modalities. Improved imaging also may alter favorably the design of future clinical trials for AMD-associated CNVs and thus reduce cost and increase the diversity of sight-saving treatments. CONCLUSIONS Delineation of the biochemical basis for CNV formation has led to development of pathway-based pharmacotherapy for AMD patients. Areas of investigation that will advance the field further include combination therapy, improved drug delivery, and improved noninvasive, high-resolution diagnostic imaging. The logistics of future clinical trials will be complicated by the need for an active treatment control group, more stringent definition of successful treatment, and the increased numbers of patients required for combination therapy studies.
Collapse
Affiliation(s)
- Marco Zarbin
- Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey 07103, USA.
| | | |
Collapse
|
39
|
Brown MM, Brown GC, Brown H. Value-based medicine and interventions for macular degeneration. Curr Opin Ophthalmol 2007; 18:194-200. [PMID: 17435425 DOI: 10.1097/icu.0b013e3281377209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the patient value conferred by interventions for neovascular macular degeneration. RECENT FINDINGS Value-based medicine is the practice of medicine based upon the patient value (improvement in quality of life and length of life) conferred by an intervention. For ophthalmologic interventions, in which length-of-life is generally unaffected, the value gain is equivalent to the improvement in quality of life. Photodynamic therapy delivers a value gain (improvement in quality of life) of 8.1% for the average person with classic subfoveal choroidal neovascularization, while laser photocoagulation for the same entity confers a 4.4% improvement in quality of life. Preliminary data suggest the value gain for the treatment of occult/minimally classic choroidal neovascularization with ranibizumab is greater than 15%. The average value gain for statins for the treatment of hyperlipidemia is 3.9%, while that for the use of biphosphonates for the treatment of osteoporosis is 1.1% and that for drugs to treat benign prostatic hyperplasia is 1-2%. SUMMARY Interventions, especially ranibizumab therapy, for neovascular macular degeneration appear to deliver an extraordinary degree of value compared with many other interventions across healthcare.
Collapse
|
40
|
Cunningham Jr ET, Adamis AP, Goldbaum M. Pegaptanib sodium for the treatment of ocular vascular disease. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.1.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
41
|
|