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E. Lee, J.-P. Hubschman, C. Gonzales, S. Schwartz; Combination Therapy: Targeted Retinal Photocoagulation (TRP) and Anti-VEGF Treatment for Retinal Vascular Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3494.
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This study investigates the utility of combination therapy involving anti-VEGF therapy and ultra-wide-angle angiographically-guided TRP in the management of diffuse macular edema from diabetic retinopathy or venous occlusive disease. The study also assesses whether TRP decreases the need for repeated anti-VEGF treatment.
A retrospective chart review of more than 1000 ultra-wide-angle angiograms, 200 cases of macular edema, 100 cases of TRP, and 100 cases of anti-VEGF treatment was performed. This yielded a total of 12 patients who had only received TRP in combination with anti-VEGF therapy. Targeted retinal photocoagulation (TRP) was guided by ultra-wide-angle fluorescein angiographic evidence of peripheral retinal ischemia. Anti-VEGF therapy (e.g. pegaptanib, bevacizumab, ranibizumab) was administered on a case-by-case basis depending upon clinical judgment. All patients underwent complete ophthalmic examination, including Snellen visual acuity, fluorescein angiography, and optical coherence tomography (OCT).
Combination therapy with anti-VEGF treatment and TRP resulted in anatomic improvement in the majority of patients reviewed. Anatomic (angiographic and OCT measures) improvement was frequently accompanied by corresponding changes in Snellen visual acuity, although some eyes were limited by macular ischemia. Four eyes had marked improvement in visual acuity with combination treatment; four eyes had transient improvement in vision; four eyes showed no improvement. The possible effect of combination TRP with anti-VEGF therapy on the number of injections given and the dosing intervals was analyzed.
Ultra-wide-angle fluorescein angiography may be useful in the management of retinal vascular macular edema by identifying areas of peripheral retinal nonperfusion. Targeted retinal photocoagulation (TRP) to areas of demonstrable ischemia may decrease the need for frequent or regular anti-VEGF treatment. Prospective clinical evaluation may be warranted.
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