Abstract
Purpose: :
To evaluate intravitreal VEGF values and inflammatory markers as well as the efficacy and safety of combination therapy with verteporfin photodynamic therapy (PDT), a corticosteroid, and bevacizumab in CNV secondary to wet AMD.
Methods: :
In 98 consecutive patients suffering from proliferative diabetic retinopathy or wet AMD intravitreal VEGF values and inflammatory markers have been measured. Patients (n=46) with idiopathic macular pucker or macular holes served as controls. Wet AMD: We report on a prospective, non-comparative, interventional case series which included 146 patients suffering from wet AMD. All lesion types and sizes have been included. All patients received a PDT with a reduced light dose. About 16 hours after PDT bevacizumab (1.5 mg) was applied intravitreally. Patients with fibrosis received 4 mg of triamcinolone, those without fibrosis received dexamethasone. Patients attended follow-up visits every 6 weeks, undergoing VA and intraocular pressure measurement, slit-lamp and ophthalmoscopic examination, and optical coherence tomography. Fluorescein angiography was performed every 3 months or earlier if OCT showed significant edema.
Results: :
Intravitreal VEGF values and inflammatory parameters were significantly (P<0.01) elevated in both, diabetic and AMD patients with a higher variability in AMD patients. In the treatment group all patients received one triple therapy cycle (9 patients received a second triple treatment due to remaining CNV activity). The triple therapy was complemented in 46 patients by an additional intravitreal injection of bevacizumab. The mean follow-up period was 53 weeks. Mean increase in visual acuity was 1.65 lines (P<0.01). Mean decrease in retinal thickness was 149 µm (P<0.01). There was no significant difference between those patients with fibrosis or without fibrosis. No serious adverse events have been observed.
Conclusions: :
The findings on both, the biochemical and clinical results further support the concept of triple therapy. When comparing the results in eyes with subretinal fibrosis with previous series a longer lasting steroid seems to be favourable in this lesion subtype. A prospective evaluation of these results is mandatory.
Keywords: inflammation • choroid: neovascularization • diabetic retinopathy