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J.M. Colina–Luquez, P.E. Liggett, D. Tom, N.A. Chaudhry, G. Haffner, C.F. Cortes; Prospective and Preliminary Study Evaluating Triple Therapy of Intravitreal Triamcinolone, Photodynamic Therapy and Pegaptanib Sodium for Choroidal Neovascularization . Invest. Ophthalmol. Vis. Sci. 2006;47(13):349.
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© ARVO (1962-2015); The Authors (2016-present)
To report anatomic and visual results of combination triple therapy (TT) consisting of high–dose intravitreal triamcinolone acetonide (HDIVTA), verteporfin–based photodynamic therapy (vPDT) and intravitreal pegaptanib sodium for subfoveal choroidal neovascularization (CNV) secondary to age–related macular degeneration (AMD).
Twenty–two eyes of 16 patients with active CNV due to AMD were included. Thirteen eyes had had prior treatment with HDIVT and vPDT with persistent CNV (prior treatment group). Nine eyes were newly diagnosed CNV with no prior treatment (new treatment group). All eyes were sequentially treated at two–week intervals with an intravitreal injection of HDIVT (10mg), followed by vPDT, followed by intravitreal pegabtanib sodium (0.3mg). Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. During follow–up, eyes with persistent or recurrent CNV, based on OCT and fluorescein angiography, were treated with intravitreal pegaptanib.
Follow–up ranged from 6 to 8 months (mean 6.8 months). In the new treatment group, the mean acuity change was an improvement of 2.2 lines, last observation carried forward [LOCF],+2.1 lines; (statistically significant Wilcoxon signed–ranks test, P = 0.013). In the prior treatment group (HDIVTA + vPDT), the mean change was an improvement of + 0.7 lines (LOCF, +0.67 lines; P = 0.55). In the new treatment group, 33% of the eyes had an improvement of 3 or more lines and only 7.96% in the prior group. Retreatment rates were 2.4 for the new treatment group and 2.6 for the prior treatment group. The mean macular thickness measured by OCT pre– treatment was 294 + 105.28 (194 to 397 microns), post–treatment OCT was mean 220 + 45.67 (range 152 to 370 micros). This was statistically significant (Wilcoxon signed–rank test, P = .006). During follow–up, six patients (27.2%) developed an intraocular pressure (IOP) of > 23 mmHg, while cataract progression was observed in 30% of phakic patients. None of the eyes developed endophthalmitis.
In this preliminary pilot study, combination therapy with HDIVTA, vPDT and pegaptanib showed improvement in visual acuity, resolution of subretinal fluid by OCT and reduction of fluorescein leakage, particularly when used as first–line therapy. Further studies are warranted to better evaluate this combination therapy for CNV secondary to AMD.
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