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