May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Quadruple Therapy and the Suspected Role of Posterior Vitreous Detachment in the Treatment of Exudative Age-Related Macular Degeneration
Author Affiliations & Notes
  • S. Shukla
    Ophthalmology, New York Medical College, Valhalla, New York
  • M. J. Koss
    Ophthalmology, University of Frankfurt, Frankfurt, Germany
  • F. H. J. Koch
    Ophthalmology, University of Frankfurt, Frankfurt, Germany
  • R. G. Josephberg
    Ophthalmology, New York Medical College, Valhalla, New York
  • Footnotes
    Commercial Relationships  S. Shukla, None; M.J. Koss, None; F.H.J. Koch, Insight Instruments, P; R.G. Josephberg, Insight Instruments, P.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 566. doi:https://doi.org/
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      S. Shukla, M. J. Koss, F. H. J. Koch, R. G. Josephberg; Quadruple Therapy and the Suspected Role of Posterior Vitreous Detachment in the Treatment of Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):566. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate the efficacy of a quadruple therapy regimen (low flouresence photodynamic therapy (PDT), intravitreal steroid injection, intravitreal Avastin injection, and a limited core pars plana vitrectomy) and a triple therapy regimen (intravitreal steroid injection, intravitreal Avastin injection, and a limited core pars plana vitrectomy) in the treatment of classic versus occult choroidal neovascularization patterns, respectively, in the treatment of exudative age-related macular degeneration (AMD).

Methods: : Patients with exudative AMD were grouped on the basis of choroidal neovascularization pattern on intravenous flourescein angiogram. Eyes in group I had predominantly classis lesions and eyes in Group II had predominantly occult lesions. Patients in both groups were treated with a limited core pars plana vitrectomy, intravitreal steroids, and intravitreal Avastin. Patients in Group I were pretreated with PDT. Visual acuity (VA) and macular thickness were measured at initial and subsequent evaluations.

Results: : One hundred fifty eight eyes were included in the study with 52 in Group I and 106 in Group II. At mean time points of 3.2, 8.7, and 13.6 months post intervention, group I showed an increase in VA of 1.1, 1.9, and 1.6 lines (p<0.01) respectively, while VA in group II improved 0.9, 1.3, and 1.2 lines (p<0.01) respectively. At the final measurement macular thickness had decreased from baseline by 211 microns (p<0.01) in group I, and 195 microns (p<0.01) in group II. Adverse events included a rise in intraocular pressure in 11/106 (10%) eyes, a pseudohypopyon in 2/106 (1.9%) eyes, and a rhegmatogenous retinal detachment in 1/106 (0.9%) eye. The retreatment rate was 25% (13/52) for group I, and 55% (58/106) for group II.

Conclusions: : Combination therapy for the treatment of exudative AMD, including the use of a limited core pars plana vitrectomy, yields a sustained improvement in visual acuity and macular thickness in eyes with predominantly classic and predominantly occult CNV. We believe the induction of a posterior vitreous detachment alters the physiology of the eye in a way that complements concurrent pharmacologic therapy for neovascular AMD.

Keywords: age-related macular degeneration • vitreous • vitreoretinal surgery 
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