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D. N. Sang, M. S. Hughes, C. Chin; Reduced Duration Photodynamic Therapy (PDT) Combined With Same Day Dexamethasone and Bevacizumab as Rescue Treatment in Patients With Previously Treated Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):564. doi: https://doi.org/.
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To evaluate the efficacy and safety of same day triple therapy with PDT with verteporfin, intravitreal dexamethasone, and intravitreal bevacizumab in the rescue treatment of exudative wet ARMD found to have failed previous anti-VEGF monotherapy and/or PDT, with or without steroid.
Forty sequential patients with previously failed treatment of exudative macular degeneration following intravitreal ranivizumab, bevacizumab, with or without triamcinolone and/or dexamethasone, were included in this prospective, non-comparative, interventional case series. Failure to respond was defined as worsening Snellen acuity with progression of activity of CNV with increasing leakage, fibrosis, or RPE detachment as assessed by OCTor FFA, despite previous therapy. Treatment protocol included reduced duration PDT (42 secs., 600mW/cm2) followed by intravitreal dexamethasone (500 micrograms) and intravitreal bevacizumab (1.25mg) at 1 hour after PDT. Subjects were monitored prospectively with assessments of best corrected Snellen visual acuity, slit lamp biomicroscopy, dilated fundus exam, FFA, and OCT. Re-treatment with bevacizumab within 1-2 months or triple therapy at 3 months was performed for recurrences. Patients were followed for 5 to 12 months.
All 40 patients received one triple therapy session. The sizes of lesions ranged from 3.8 to 6.2 mm. 53% of patients required additional treatment. Increased Snellen visual acuity was found in 46% of eyes, with 87% the same or better. 68% showed improvement in OCT central thickness. 46% of patients had presented with RPE detachments >300 microns thickness. 60% of patients had demonstrated >50% fibrosis. The presence of > 50% fibrosis or RPE detachment >300 microns thickness was correlated with less favorable outcome. There was no correlation with lesion type. In many cases, anatomical improvement occurred without improvement in visual acuity. No adverse events were noted. Further follow-up will be presented.
A triple regimen of reduced duration PDT followed by same day intravitreal dexamethasone and bevacizumab may offer a clinical benefit as rescue therapy in eyes with advancing exudative macular degeneration despite failture to respond to previous treatment with anti-VEGF monotherapy and/or PDT, with or without steroid.
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