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D. Veritti, P. Lanzetta, M. L. Cascavilla, D. Drigo, F. Bandello; Triple Therapy for Choroidal Neovascularization Due to Age-Related Macular Degeneration. Ranibizumab, Modified Juxtascleral Triamcinolone Acetonide, and Verteporfin PDT. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1908.
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To evaluate the safety and exploratory efficacy of triple therapy (TT) with intravitreal ranibizumab, modified juxtascleral triamcinolone acetonide, and verteporfin photodynamic therapy (PDT) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).
Thirty sequential eyes with CNV due to AMD were included in this prospective, interventional case series. The first ten eyes (group 1) enrolled received triple therapy (TT) with standard fluence/standard irradiance PDT (50 J/cm2, 600 mW/cm2), group 2 received TT with reduced fluence/standard irradiance PDT (25 J/cm2, 600 mW/cm2), the last ten eyes included (group 3) were treated with TT with reduced fluence/reduced irradiance PDT (25 J/cm2, 300 mW/cm2). Patients were scheduled for follow-up examinations at 7 days, 1, 3 and 6 months. Best corrected visual acuity (BCVA), fluorescein angiography (FA), indocyanine green angiography (ICGA) and retinal optical coherence tomography (OCT) were performed at baseline and at each follow-up visit. Retreatement with intravitreal ranibizumab was considered at investigator discretion from month 3.
All patients completed the 6 months follow-up. Mean BCVA at baseline was 1.1 (±0.5) logMAR (group 1), 0.9 (±0.6) logMAR (group 2) and 1.1 (±0.5) logMAR (group 3). At the end of the follow-up, mean BCVA change was 0.29 (±0.39) logMAR (group 1), -0.13 (±0.34) logMAR (group 2) and -0.15 (±0.22) logMAR (group 3). Mean number of ranibizumab injections per patient in the pro re nata phase was 0.5 (group 1), 0.8 (group 2), and 0.7 (group 3). A hypofluorescent area corresponding to the laser spot was visible at fluorescein angiography and indocianine green angiography at 6 months in 90% of eyes in group 1, 40% of those in group 2, and in 30% of group 3. Among eyes treated with standard fluence/standard irradiance PDT, two showed choroidal ischemia.
The combination of modified juxtascleral triamcinolone acetonide, verteporfin with reduced fluence PDT, and intravitreal ranibizumab is a safe treatment option for CNV due to AMD, induces a characteristic sequence of vascular changes and can lead to absence of angiographic leakage for six months. Triple therapy can potentially offer a new treatment modality for CNV due to AMD while reducing treatment frequency.
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