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Photodynamic therapy combined with intravitreal bevacizumab and sub-tenon triamcinolone acetonide injections for age-related macular degeneration

  • Clinical Investigation
  • Published:
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Abstract

Purpose

To report the results of triple therapy with photodynamic therapy (PDT) (PDT combined with intravitreal injection of bevacizumab (IVB) and sub-tenon injection of triamcinolone acetonide (STTA)) for the treatment of age-related macular degeneration (AMD) in Japanese patients.

Methods

This retrospective case series included 38 eyes of 38 patients with exudative AMD treated with PDT combined with IVB (1.25 mg) and STTA (40 mg). Retreatment was performed in the same manner with intervals of at least 3 months. All patients had been treatment naïve, with a follow-up period of 12 months. Best-corrected visual acuity (BCVA), macular retinal thickness (MRT) on optical coherence tomography, and the number of treatments were analyzed.

Results

The mean logarithm of the minimum angle of resolution BCVA in patients treated with PDT triple therapy was 0.86 ± 0.55 at baseline and 0.62 ± 0.55 at 12 months (p < 0.001). The mean MRT was 554.0 ± 202.6 μm at baseline and 205.1 ± 78.6 μm at 12 months (p < 0.001). During the 1-year follow-up, the average number of PDT triple therapy (treatments per patient) was 1.1. No complications, for example increase in intraocular pressure, cataract, or endophthalmitis, were observed.

Conclusions

In AMD patients, PDT triple therapy significantly improved visual acuity with a minimum number of treatments and a low risk of complications during the 1-year follow-up.

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References

  1. Schmidt-Erfurth U, Laqua H, Schlotzer-Schrehard U, Viestenz A, Naumann GO. Histopathological changes following photodynamic therapy in human eyes. Arch Ophthalmol. 2002;120:835–44.

    PubMed  Google Scholar 

  2. Kaiser PK, Brown DM, Zhang K, Hudson HL, Holz FG, Shapiro H, et al. Ranibizumab for predominantly classic neovascular age-related macular degeneration: subgroup analysis of first-year Anchor results. Am J Ophthalmol. 2007;144:850–7.

    Article  PubMed  CAS  Google Scholar 

  3. Kaiser PK, Blodi BA, Shapiro H, Acharya NR. Angiographic and optical coherence tomographic results of the Marina study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology. 2007;114:1868–75.

    Article  PubMed  Google Scholar 

  4. Boyer DS, Antoszyk AN, Awh CC, Bhisitkul RB, Shapiro H, Acharya NR. Subgroup analysis of the Marina study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology. 2007;114:246–52.

    Article  PubMed  Google Scholar 

  5. Ueta T, Yanagi Y, Tamaki Y, Yamaguchi T. Cerebrovascular accidents in ranibizumab. Ophthalmology. 2009;116:362.

    Article  PubMed  Google Scholar 

  6. Shah GK, Sang DN, Hughes MS. Verteporfin combination regimens in the treatment of neovascular age-related macular degeneration. Retina. 2009;29:133–48.

    Article  PubMed  Google Scholar 

  7. Ruiz-Moreno JM, Montero JA, Barile S, Zarbin MA. Photodynamic therapy and high-dose intravitreal triamcinolone to treat exudative age-related macular degeneration: 1-year outcome. Retina. 2006;26:602–12.

    Article  PubMed  Google Scholar 

  8. Tano Y. Guidelines for PDT in Japan. Ophthalmology. 2008;115(585–585):e6.

    PubMed  Google Scholar 

  9. Schmidt-Erfurth UM, Michels S. Changes in confocal indocyanine green angiography through two years after photodynamic therapy with verteporfin. Ophthalmology. 2003;110:1306–14.

    Article  PubMed  Google Scholar 

  10. Carroll LA, Hanasono MM, Mikulec AA, Kita M, Koch RJ. Triamcinolone stimulates bFGF production and inhibits TGF-β1 production by human dermal fibroblasts. Dermatol Surg. 2002;28:704–9.

    Article  PubMed  Google Scholar 

  11. Tamura H, Miyamoto K, Kiryu J, Miyahara S, Katsuta H, Hirose F, et al. Intravitreal injection of corticosteroid attenuates leukostasis and vascular leakage in experimental diabetic retina. Invest Ophthalmol Vis Sci. 2005;46:1440–4.

    Article  PubMed  Google Scholar 

  12. Sakurai E, Taguchi H, Anand A, Ambati BK, Gragoudas ES, Miller JW, et al. Targeted disruption of the CD18 or ICAM-1 gene inhibits choroidal neovascularization. Invest Ophthalmol Vis Sci. 2003;44:2743–9.

    Article  PubMed  Google Scholar 

  13. CATT Research Group, Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364:1897–908.

    Article  PubMed  CAS  Google Scholar 

  14. Ahmadieh H, Taei R, Soheilian M, Riazi-Esfahani M, Karkhaneh R, Lashay A, et al. Single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration. BMC Ophthalmol. 2007;7:10.

    Article  PubMed  Google Scholar 

  15. Shirakata Y, Shiragami C, Yamashita A, Nitta E, Fujiwara A, Shiraga F. One-year results of intravitreal bevacizumab and posterior subtenon injection of triamcinolone acetonide with reduced laser fluence photodynamic therapy for retinal angiomatous proliferation. Jpn J Ophthalmol. (in press).

  16. Kovacs KD, Quirk MT, Kinoshita T, Gautam S, Ceron OM, Murtha TJ, et al. A retrospective analysis of triple combination therapy with intravitreal bevacizumab, posterior sub-tenon’s triamcinolone acetonide, and low-fluence verteporfin photodynamic therapy in patients with neovascular age-related macular degeneration. Retina. 2010;31:446–52.

    Article  Google Scholar 

  17. Jonas JB. Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand. 2005;83:645–63.

    Article  PubMed  Google Scholar 

  18. Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.

    Article  PubMed  Google Scholar 

  19. Gomi F, Ohji M, Sayanagi K, Sawa M, Sakaguchi H, Oshima Y, et al. One-year outcomes of photodynamic therapy in age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology. 2008;115:141–6.

    Article  PubMed  Google Scholar 

  20. Gomi F, Tano Y. Polypoidal choroidal vasculopathy and treatments. Curr Opin Ophthalmol. 2008;19:208–12.

    Article  PubMed  Google Scholar 

  21. Honda S, Kurimoto Y, Kagotani Y, Yamamoto H, Takagi H, Uenishi M. Photodynamic therapy for typical age-related macular degeneration and polypoidal choroidal vasculopathy: a 30-month multicenter study in Hyogo, Japan. Jpn J Ophthalmol. 2009;53:593–7.

    Article  PubMed  CAS  Google Scholar 

  22. Saito K, Yamamoto T, Tsuchiya D, Kawasaki R, Haneda S, Yamashita H. Effect of combined treatment with sub-Tenon injection of triamcinolone acetonide and photodynamic therapy in Japanese patients with age-related macular degeneration. Jpn J Ophthalmol. 2009;53:512–8.

    Article  PubMed  CAS  Google Scholar 

  23. Sato T, Kishi S, Matsumoto H, Mukai R. Combined photodynamic therapy with verteporfin and intravitreal bevacizumab for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010;149:947–54.

    Article  PubMed  CAS  Google Scholar 

  24. Gomi F, Sawa M, Wakabayashi T, Sasamoto Y, Suzuki M, Tsujikawa M. Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2010;150(48–54):e1.

    PubMed  Google Scholar 

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Correspondence to Wataru Saito.

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Yoshizawa, C., Saito, W., Hirose, S. et al. Photodynamic therapy combined with intravitreal bevacizumab and sub-tenon triamcinolone acetonide injections for age-related macular degeneration. Jpn J Ophthalmol 57, 68–73 (2013). https://doi.org/10.1007/s10384-012-0206-8

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  • DOI: https://doi.org/10.1007/s10384-012-0206-8

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