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S. M. Couch, S. J. Bakri, C. A. McCannel, A. O. Edwards; Same Day Triple Therapy With Reduced Fluence Photodynamic Therapy, Intravitreal Dexamethasone and Bevacizumab in Patients With Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1133.
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To report the results of same day triple therapy with reduced fluence photodynamic therapy (PDT), intravitreal dexamethasone, and bevacizumab in patients with neovascular age-related macular degeneration (AMD).
Retrospective case series of thirty one patients with neovascular AMD. All patients who received same day triple therapy with reduced fluence photodynamic therapy (25 J/cm2), intravitreal dexamethasone (200mcg) and intravitreal bevacizumab (1.25mg). Main outcome measures were Snellen visual acuity (VA), central macular thickness (CMT) on optical coherence tomography (OCT), need for retreatment, intraocular pressure, and endophthalmitis occurrence.
Average followup for the thirty one patients was 13.7 months. In all patients, mean baseline VA was 20/80 and vision at final followup was 20/60 (p=0.69). In patients who received previous treatment for exudative AMD (n=18), mean baseline VA was 20/100 and vision at final followup was 20/100 (p=0.31). In treatment-naïve patients (n=13), mean baseline VA was 20/60 and vision at final followup was 20/40 (p=0.31). In all patients, mean CMT was 293 um at baseline and 245 um at final followup (p=0.053). In previously treated patients (n=18) mean CMT was 325 um at baseline and 265 um at final followup (p=0.10). In treatment-naïve patients, mean CMT was 249 um at baseline (n=13) and 218 um at final followup (p=0.34). Previously treated patients required more anti-VEGF injections (mean = 3.6) than treatment-naïve patient (mean = 0.8), but the mean number of repeat triple therapy treatments was 0.3 in both groups. Changes in intraocular pressure and endophthalmitis were not observed during followup.
Same-day combination therapy with reduced fluence PDT, intravitreal bevacizumab and dexamethasone preserved visual acuity and decreased macular thickness in patient with and without previous anti-VEGF therapy. Same-day triple therapy may reduce the number of anti-VEGF injections in some patients and stabilize vision in some patients not responding to anti-VEGF therapy.
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