Abstract
Purpose: :
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).
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Clinical Trial: :
www.chictr.org ChiCTR-TNRC-00000175
Keywords: age-related macular degeneration • choroid: neovascularization • photodynamic therapy