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A. J. Augustin, J. Kirchhof, J. Lutz; Intravitreal VEGF Values and Inflammatory Parameters - Rationale and Clinical Results of an Individualized Combination-treatment of Wet AMD. Invest. Ophthalmol. Vis. Sci. 2009;50(13):953.
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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.
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.
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.
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.
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