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Barbazetto IA, Takahashi BS. Verteporfin photodynamic therapy in the age of antiangiogenic therapy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.3.4.365] [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: 01/22/2023]
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Ruiz-Moreno JM, Montero JA. Combined treatment of exudative age related macular degeneration with photodynamic therapy and intravitreal triamcinolone. Clin Ophthalmol 2011; 2:71-5. [PMID: 19668390 PMCID: PMC2698720 DOI: 10.2147/opth.s1643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Choroidal neovascularization (CNV) secondary to age related macular degeneration is among the leading causes of legal blindness in developed countries. Photodynamic therapy (PDT) with verteporfin induces CNV closure causing little damage to healthy tissue, but the need to re-treat may lead to low final visual acuity at an unacceptable cost. The association of intravitreous triamcinolone or antiangiogenic drugs with PDT has been used in order to reduce these limitations of the therapy. The combination of PDT and intravitreous triamcinolone, its complications and outcome at one and two-year follow-up are discussed.
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Affiliation(s)
- José M Ruiz-Moreno
- Department of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain.
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Focal macular electroretinograms after photodynamic therapy combined with intravitreal bevacizumab. Graefes Arch Clin Exp Ophthalmol 2010; 249:273-80. [PMID: 21038080 DOI: 10.1007/s00417-010-1548-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 10/05/2010] [Accepted: 10/10/2010] [Indexed: 09/29/2022] Open
Abstract
BACKGROUND Retinal function is transiently depressed after photodynamic therapy (PDT) alone. One of the reasons for this functional impairment is a reduction of choroidal circulation caused by the PDT. The purpose of this study was to determine whether PDT combined with intravitreal bevacizumab (PDT+IVB) can reduce or prevent the transient impaired macular function. In addition, we examined whether a significant correlation existed between the changes in the focal macular electroretinograms (FMERGs), optical coherence tomography (OCT)-determined morphology, and changes in choroidal circulation. METHODS Thirty-eight eyes that were treated by full fluence PDT+IVB were studied. FMERGs, OCT, and indocyanine green angiography (ICGA) were performed before and after the PDT. The intensity of the diffuse fluorescence within the PDT site was measured by densitometry (I/N ratio). RESULTS The macula was significantly thinner 1 week after PDT+IVB (P < 0.01). The mean a- and b-wave amplitudes of the FMERGs were not significantly decreased 1 week after PDT+IVB. The mean b-wave amplitudes 3 months after PDT+IVB were significantly increased (P < 0.01). The I/N ratio of ICGA 3 months after PDT+IVB was 0.88 ± 0.1. The correlation between the FMERGs and I/N ratio was not significant. CONCLUSION The use of IVB with PDT mitigates the reduction of the FMERGs and reduces the macular thickness soon after PDT, regardless of the degree of impairment of choroidal circulation caused by PDT. Finally, the macular retinal function 3 months after PDT+IVB were better than that before the treatment.
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Effect of photodynamic therapy alone or combined with posterior subtenon triamcinolone acetonide or intravitreal bevacizumab on choroidal hypofluorescence by indocyanine green angiography. Retina 2010; 30:495-502. [PMID: 19996828 DOI: 10.1097/iae.0b013e3181bcedbe] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Choroidal hypofluorescence has been reported beneath the photodynamic therapy (PDT) site in clinical studies. We evaluated the choroidal hypofluorescence after combined PDT with posterior subtenon injection of triamcinolone acetonide or PDT with an intravitreal injection of bevacizumab for age-related macular degeneration. METHODS Two hundred and forty-two eyes with a subfoveal choroidal neovascularization caused by age-related macular degeneration were studied. Ninety-two eyes underwent PDT alone, 90 eyes underwent PDT with sub-Tenon injection of triamcinolone acetonide, and 60 eyes underwent PDT with intravitreal injection of bevacizumab. Verteporfin-induced choroidal hypoperfusion was determined by indocyanine green angiograms. The intensity of the diffuse fluorescence within the PDT site away from the choroidal neovascularization lesion and from the normal retina just peripheral to the optic disk was measured by densitometry (Topcon IMAGEnet computer system, Topcon, Tokyo, Japan) in the indocyanine green angiogram images obtained at 10 minutes 3 months after the PDT. The ratio of the average brightness of the retina within the PDT area to that of the retina peripheral to the optic disk (irradiated/nonirradiated retinal brightness ratio) was calculated for each angiogram. RESULTS The irradiated/nonirradiated retinal brightness ratio of the angiograms was 0.96 in the PDT-alone group, 0.85 in the sub-Tenon injection of triamcinolone acetonide-PDT group, and 0.89 in the intravitreal injection of bevacizumab-PDT group (Kruskal-Wallis H test, P < 0.05). CONCLUSION The degree of choroidal hypofluorescence in the indocyanine green angiogram images 3 months after PDT in the sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab group was higher than that of PDT-alone group. Sub-Tenon injection of triamcinolone acetonide and intravitreal injection of bevacizumab can prolong the duration of the choroidal hypofluorescence after PDT.
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Cardascia N, Furino C, Ferrara A, Boscia F, Alessio G. Treatment of recurrent retinal angiomatous proliferation with intravitreal triamcinolone acetonide followed by photodynamic therapy with verteporfin: A retrospective case series. Curr Ther Res Clin Exp 2009; 70:240-51. [PMID: 24683234 DOI: 10.1016/j.curtheres.2009.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to report the effect on tolerability of combined treatment with intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) with verteporfin in patients with stage II retinal angiomatous proliferation (RAP) who had been treated previously with PDT and presented with recurrent RAP (R-RAP). METHODS This was a retrospective case series of patients with R-RAP after PDT (1-5 treatments) treated once with IVT followed 1 month later by PDT. A visual acuity test, fluorescein and indocyanine green angiography, and optical coherence tomography were performed at baseline and at 1, 3, and 6 months. RESULTS Five patients (4 men, 1 woman; mean [SD] age, 76.8 [3.9] years) with 6 eyes diagnosed with stage II R-RAP who had previously been treated with PDT and who received an IVT injection and PDT within 1 month were included in the study. Best corrected visual acuity (BCVA) remained stable after IVT in 5 eyes (83%) and deteriorated in 1 eye (17%). After PDT, BCVA remained stable in 2 eyes (33%) and deteriorated in 4 eyes (67%). IVT treatment combined with PDT also reduced fluorescein leakage. Median lesion size increased 24% before PDT and 61% at 6 months after PDT. One eye had intraocular hypertension at 3 months, and 1 eye developed a pigment epithelial tear after PDT. CONCLUSION The results were limited by the number of eyes and relatively short follow-up, but in this study, PDT after IVT did not appear to be as effective or well tolerated in 5 patients who had already been treated with PDT and presented with R-RAP.
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Affiliation(s)
- Nicola Cardascia
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Claudio Furino
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Andrea Ferrara
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Francesco Boscia
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology, Policlinico of Bari, University of Bari, Bari, Italy
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Frimpong-Boateng A, Bunse A, Rüfer F, Roider J. Photodynamic therapy with intravitreal application of triamcinolone acetonide in age-related macular degeneration: functional results in 54 patients. Acta Ophthalmol 2009; 87:183-7. [PMID: 18547278 DOI: 10.1111/j.1755-3768.2008.01213.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD). METHODS A retrospective analysis of clinical data for 54 patients with CNV resulting from AMD was carried out. All patients had a follow-up of 12 months. The patients were treated with standardized PDT and IVTA (4 mg) as a first-line treatment or following PDT failure. Visual acuity (VA), greatest linear diameter (GLD) of the CNV and foveal thickness were evaluated. RESULTS Mean VA at baseline was 0.8 logMAR (0.4-1.4). After 12 months VA improved (> 2 lines) in 20.4% of patients and stabilized (+/- 2 lines) in 64.8%. There was no statistical significance in VA outcome between patients undergoing first-line treatment and patients with PDT failure; however, fewer PDT treatments were required to stop CNV activity in patients undergoing first-line treatment. At 12 months, a reduction in foveal thickness was seen in 67.7% of patients and a reduction in CNV GLD in 32.7%. Complications occurred in 22% of patients and included a transient rise in intraocular pressure, cataract and sterile hypopyon. CONCLUSIONS Our analysis shows that fewer PDT treatments were required to stop CNV activity when triamcinolone was used as first-line treatment. We can thus conclude that PDT combines synergistically with IVTA and the combination may lead to a cost reduction compared with PDT therapy alone. The overall complication rate of 22% is high and must be compared with complication rates caused by new intravitreal anti-VEGF (vascular endothelial growth factor) drugs in combination with PDT.
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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]
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Secondary Elevated IOP and Cataracts After High-dose Intravitreal Triamcinolone and Photodynamic Therapy to Treat Choroidal Neovascularization. J Glaucoma 2009; 18:69-72. [DOI: 10.1097/ijg.0b013e31816b3037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Photodynamic therapy of subfoveal choroidal neovascularization]. SRP ARK CELOK LEK 2008; 135 11-12:629-34. [PMID: 18368902 DOI: 10.2298/sarh0712629g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Photodynamic therapy (PDT) is a method of treatment of choroidal neovascularization (CNV) with a diode laser used after intravenously administered verteporfin. Verteporfin is a light-activated drug initiating photochemical reactions in the target tissue. This leads to the selective occlusion of blood vessels in the CNV with no damage of photoreceptors, retinal pigment epithelium and retinal blood vessels. OBJECTIVE To show the results of the treatment of predominantly classic subfoveal CNV with PDT with verteporfin used for the first time in our country. METHOD From 2003 to 2005, we treated 15 eyes in 15 patients using PDT and verteporfin, because of predominantly classic subfoveal CNV. If macular oedema was present as proved by fluorescein angiography, triamcinolone was administered intravitreally after FDT. Average follow-up period was 7 months (3 months to 2 years). STUDY DESIGN retrospective, noncomparative, consecutive case series. RESULTS Two thirds of patients had CNV due to AMD, while in others it was caused by pathologic myopia, chorioretinitis, angioid streaks, choroidal hemangioma, except for one patient who had idiopathic CNV. Visual acuity was stabile in 60% (9/15) of patients, of whom in 60% (6/10) of patients with AMD, as well as in patients with pathologic myopia, idiopathic CNV and choroidal hemangioma. Retreatment with PDT was indicated in 40% (6/15) and in 50% (5/10) of patients with AMD, mostly 4-6 months after first PDT, but was done only in one patient (economic reasons). In two patients with AMD, triamcinolone was administered intravitreally for 2-4 months, which resulted in the stabilization of visual acuity. CONCLUSION Visual acuity was stabile in 60% of all treated patients with predominantly classic subfoveal CNV after only one application of PDT with verteporfin during the average follow-up of 7 months (3 months to 2 years). Retreatment was indicated in 40% of the treated patients, and in 50% of patients with AMD. As confirmed, intravitreal administration of triamcinolone after PDT could stabilize visual acuity. Side effects were not noticed.
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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.
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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
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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]
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COMBINED PHOTODYNAMIC THERAPY AND INTRAVITREAL TRIAMCINOLONE FOR CHOROIDAL NEOVASCULARIZATION SECONDARY TO PUNCTATE INNER CHOROIDOPATHY OR OF IDIOPATHIC ORIGIN. Retina 2008; 28:71-80. [DOI: 10.1097/iae.0b013e31815e9339] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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.
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Affiliation(s)
- Lekha Gopal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Vision Research Foundation, 18 College Road, Chennai - 600 006, India.
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Mennel S, Barbazetto I, Meyer CH, Peter S, Stur M. Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 2). Ophthalmologica 2007; 221:282-91. [PMID: 17728549 DOI: 10.1159/000104757] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 03/23/2007] [Indexed: 11/19/2022]
Abstract
Photodynamic therapy (PDT) has become a well-established treatment for vascular forms of age-related macular degeneration (AMD). The implementation of evidence-based medicine principles into the treatment regimen of AMD seems to be immensly important, since AMD continues to be the most frequent cause of blindness among patients older than 65 years in industrialized countries. Numerous randomized prospective studies demonstrated high levels of evidence for the efficacy of various treatment approaches such as laser photocoagulation, PDT, subretinal surgery or novel anti-angiogenic drugs [Arch Ophthalmol 2006;124:597-599]. The high evidence shown by these studies supported the rationale to use PDT also in additional, less frequent, vasoproliferative diseases. Although these 'case series' and 'individual case control studies' have a low level of evidence, they give us important information for treatment decisions in these rare conditions. The goal of this survey is to review the current literature regarding PDT in vasoproliferative and exudative ocular diseases outside AMD. Many studies modified the treatment parameters of PDT to address the specific pathology of the underlying disease. Table 1 summarizes the diseases and treatment parameters that are described in this part 2, the entire table of this review is included in part 1 (www.karger.com/doi/10.1159/ 000101922).
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Affiliation(s)
- Stefan Mennel
- Department of Ophthalmology, Philipps University, Marburg, Germany.
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Schadlu R, Kymes SM, Apte RS. Combined photodynamic therapy and intravitreal triamcinolone for neovascular age-related macular degeneration: effect of initial visual acuity on treatment response. Graefes Arch Clin Exp Ophthalmol 2007; 245:1667-72. [PMID: 17583819 DOI: 10.1007/s00417-007-0619-0] [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] [Received: 03/09/2007] [Revised: 05/15/2007] [Accepted: 05/28/2007] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate visual outcomes in combination therapy with photodynamic therapy (PDT) and intravitreal triamcinolone acetonide (IVTA) for subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD). METHODS Charts of 39 eyes from 38 patients with exudative AMD treated with PDT and 4 mg of triamcinolone acetate injected intravitreally were reviewed retrospectively. Visual data, angiographic lesion type, prior PDT exposure, number of treatments, and follow-up were recorded. Snellen visual acuities were converted to LogMAR for all calculations. Lines of vision lost or gained pertain to calculated ETDRS lines of vision (via LogMAR). RESULTS Twenty-two of the choroidal neovascular membranes were occult, and 17 were classified as predominantly classic. Mean follow-up was 43 weeks. The average number of treatments was 2.23. At final follow-up, 11 eyes (28.21%) experienced improved visual acuity, 8 eyes (20.51%) were stable, and 20 eyes (51.28%) had worsened. No significant difference in treatment response was found between angiographic subtypes (p > 0.59). Lack of previous PDT exposure did not improve treatment outcomes (p > 0.77). Pre-treatment visual acuity (PTVA) was determined as a strong predictor of treatment outcome in our study cohort. Visual acuity of 20/200 or worse was associated with a 40.9% chance of some improvement and a 35.75% chance of three or more lines of improvement. Visual acuity better than 20/200 was associated with an 89.4% chance of no improvement and a 58.8% chance of three or more lines of visual loss. CONCLUSION Counter to previously reported results with combination therapy, the majority of our patients (72%) did not demonstrate improved vision and 51% lost vision. When PTVA was accounted for, selected patients benefitted significantly from treatment. PTVA may be a useful and simple patient selection tool for combination treatment with PDT and IVTA.
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Affiliation(s)
- Ramin Schadlu
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, Barnes Retina Institute, St. Louis, MO 63110, USA
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Augustin AJ, Puls S, Offermann I. Triple therapy for choroidal neovascularization due to age-related macular degeneration: verteporfin PDT, bevacizumab, and dexamethasone. Retina 2007; 27:133-40. [PMID: 17290193 DOI: 10.1097/iae.0b013e3180323de7] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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, accomplished by light delivery time of 70 seconds). Approximately 16 hours after PDT, dexamethasone (800 microg) 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 < 0.01). Mean decrease in retinal thickness was 182 microm (P < 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.
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Affiliation(s)
- Albert J Augustin
- Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, Germany.
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Ruiz-Moreno JM, Montero JA, Zarbin MA. PHOTODYNAMIC THERAPY AND HIGH-DOSE INTRAVITREAL TRIAMCINOLONE TO TREAT EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2007; 27:458-61. [PMID: 17420698 DOI: 10.1097/iae.0b013e318030c77c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy of photodynamic therapy (PDT) and high-dose intravitreal triamcinolone acetonide (TA) injection to treat choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD) at the 2-year follow-up. METHODS In this prospective, consecutive, comparative, nonrandomized, interventional case series, 30 eyes of 30 consecutive patients with subfoveal CNV associated with AMD were treated by PDT followed by intravitreal injection of 19.4 +/- 2.1 mg TA. Fifteen eyes were naive to treatment (group 1), and 15 had been treated previously by PDT alone (group 2). A group of 15 eyes of 15 patients treated by PDT alone served as controls. The number of Snellen lines gained or lost and PDT sessions were evaluated. RESULTS Best-corrected visual acuity (BCVA) did not change significantly in group 1 from baseline (0.0 +/- 3.4 Snellen line; range, -5 to 9 Snellen lines; P = 0.81); group 2 lost an average -0.6 +/- 2.5 line (range, -7 to 3 Snellen lines) (P = 0.41), and the control group lost an average of -2.2 +/- 3.4 lines (range, -8 to 2 Snellen lines) (P = 0.03, Wilcoxon signed rank test). The average number of PDT sessions during the 24-month follow-up was 1.9, 1.2, and 3.9 for group 1, group 2, and the control group, respectively. CONCLUSION Two years after combined PDT/high-dose intravitreal TA to treat AMD-associated CNV, final BCVA was stable, and the need for retreatment was reduced compared with historical controls.
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Affiliation(s)
- José M Ruiz-Moreno
- Department of Ophthalmology, Miguel Hernández University School of Medicine, Alicante, Spain.
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Costa RA, Jorge R, Calucci D, Melo LAS, Cardillo JA, Scott IU. Intravitreal bevacizumab (Avastin) in combination with verteporfin photodynamic therapy for choroidal neovascularization associated with age-related macular degeneration (IBeVe Study). Graefes Arch Clin Exp Ophthalmol 2007; 245:1273-80. [PMID: 17333238 DOI: 10.1007/s00417-007-0557-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/09/2007] [Accepted: 02/11/2007] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND A novel alternative for combined treatment using verteporfin photodynamic therapy (PDT) has emerged as preliminary safety and efficacy data of the intravitreal use of the anti-angiogenic bevacizumab became available. In the current study we investigate the feasibility of intravitreal bevacizumab combined with verteporfin PDT for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). METHODS A single-centre, prospective, open-label study of 11 patients with documented CNV progression after PDT treatment who underwent combined PDT and intravitreal injection of 1.5 mg of bevacizumab was undertaken. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 2, 12 and 24. Clinical evidence of complications and changes in logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and in fluorescein leakage from CNV were evaluated. RESULTS The mean (+/-SD) age of the 11 patients was 74 (+/-5) years. Seven eyes had been treated with one previous PDT session and four eyes had two previous PDT sessions. The mean baseline logMAR ETDRS BCVA was 1.031 (Snellen equivalent, 20/200(-2)). At follow-up weeks 1, 2, 12 and 24, the mean logMAR ETDRS BCVA (Snellen equivalent) was 0.944 (20/160(-2)), 0.924 (20/160(-1)), 0.882 (20/160(+1)), and 0.933 (20/160(-2)), respectively. The change in BCVA from baseline was significant at each study follow-up interval (P < or = 0.001); at 12 and 24 weeks, the mean change in BCVA from baseline was an improvement of 1.49 and of 0.98 ETDRS line, respectively. Fluorescein leakage from CNV was absent in all eyes at week 12. One additional treatment session was required in seven (63.6%) eyes at week 24 due to recurrent fluorescein leakage from CNV ("minimum" [<50% of the leaking area noted at baseline], n = 4; and "moderate" [>50% of the leaking area noted at baseline], n = 3). No progression of the neovascular lesion was observed at week 24. No safety issues were identified throughout the period of the study. CONCLUSIONS The overall changes in vision and fluorescein leakage from CNV throughout the study suggest that a possible synergistic effect may arise from the combination of intravitreal bevacizumab with verteporfin PDT for the treatment of neovascular AMD.
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Affiliation(s)
- Rogério A Costa
- U.D.A.T. Macular Imaging & Treatment Division, Hospital de Olhos de Araraquara, Rua Padre Duarte 989 apto 172, Araraquara, SP 14801-310, Brazil.
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Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness that until recently had no recognised drug treatment. In wet AMD, choroidal neovascularisation (CNV) causes a profound loss of central vision. CNV is a complex process in which tissue ischaemia and/or inflammation is thought to trigger production of angiogenic signal molecules. The release of VEGF appears to be particularly important. Verteporfin photodynamic therapy was the first drug therapy to be licensed for the treatment of some types of wet AMD. Other treatments directly targeting VEGF or other aspects of angiogenesis, such as pegaptanib, ranibizumab and anecortave acetate, have either recently been licensed or are in the advanced stages of development. These and other promising treatment options such as combination strategies are reviewed.
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Affiliation(s)
- Albert J Augustin
- Eye Clinic, Department of Ophthalmology, Moltkestrasse 90, 76133 Karlsruhe, Germany.
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Yeoh J, Sims J, Guymer RH. A review of drug options in age-related macular degeneration therapy and potential new agents. Expert Opin Pharmacother 2006; 7:2355-68. [PMID: 17109611 DOI: 10.1517/14656566.7.17.2355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of legal blindness in people > 50 years of age in the developed world. AMD is both a debilitating and costly disease for the individual and the community. Greater understanding of the mechanisms and pathways involved in causing the visual loss in AMD has resulted in the advent of several newer and more effective treatment options, making it an exciting time in the management of AMD. This paper will examine the principles behind the existing drug therapies available, as well as those being developed in the management or prophylaxis of AMD and its vision-threatening complications.
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Affiliation(s)
- Jonathan Yeoh
- Centre for Eye Research Australia, The University of Melbourne, Australia
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22
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Ruiz-Moreno JM, Montero JA. Photodynamic therapy in macular diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.1.97] [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]
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Reply. Retina 2006. [DOI: 10.1097/00006982-200607000-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Correspondence. Retina 2006. [DOI: 10.1097/00006982-200607000-00029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ho TC. Correspondence. Retina 2006; 26:714; author reply 715. [PMID: 16829825 DOI: 10.1097/01.iae.0000236477.09561.d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nicolò M, Ghiglione D, Lai S, Calabria G. Retinal angiomatous proliferation treated by intravitreal triamcinolone and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol 2006; 244:1336-8. [PMID: 16523293 DOI: 10.1007/s00417-006-0306-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 02/06/2006] [Accepted: 02/06/2006] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To examine combined treatment of intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) for retinal angiomatous proliferation (RAP). METHODS Ten eyes of eight consecutive patients with RAP underwent a single injection (about 20 mg) of IVT followed 1 month later by PDT. Best-corrected visual acuity (BCVA) was measured by standardized protocol refraction. RESULTS Median BCVA was 20/160, 20/64, 20/98, 20/89, 20/89, 20/125 at baseline and 1, 3, 6, 9 and 12 months, respectively. Of ten eyes, six (60%) improved BCVA of at least 3 lines at 1, 3, 6 and 9 months. Four (40%) eyes improved BCVA of at least 3 lines at 12 months. Three eyes (30%) lost >3 lines at 12 months. In all patients intraocular pressure was well controlled. No endophthalmitis, retinal detachment or vitreous haemorrhage developed. CONCLUSIONS Improvement of BCVA suggests that combination treatment with IVT and PDT for RAP merits further investigation.
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Affiliation(s)
- Massimo Nicolò
- Dipartimento di Neuroscienze, Oftalmologia e Genetica, Sezione di Clinica Oculistica, Università di Genova, Osp. San Martino, Pad. 9, piano terra stanza 13. Largo R. Benzi 10, 16132, Genova, Italy.
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