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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.
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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).
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.
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.
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.
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