Intravitreal Ranibizumab and Bevacizumab in Combination with Full-Fluence Verteporfin Therapy and Dexamethasone for Exudative Age-Related Macular Degeneration

Abstract

Purpose: To evaluate the efficacy and safety of triple therapy with intravitreal anti-vascular-endothelial-growth-factor (VEGF) antibody, dexamethasone and verteporfin photodynamic therapy (PDT) for exudative age-related macular degeneration (AMD). Methods: Retrospective, comparative, interventional study. Records of treatment-naïve patients who received intravitreal bevacizumab or ranibizumab in monotherapy or in combination with dexamethasone and full-fluence verteporfin PDT in triple therapy were reviewed. logMAR visual acuity, foveal thickness (FT) on optical coherence tomography, intraocular pressure and endophthalmitis occurrence were recorded. Results: Sixty-one eyes were included in the triple-therapy group, 40 eyes were included in the monotherapy group. The mean follow-up was 14.1 ± 3.4 months in the triple-therapy group and 16.3 ± 4.1 months in the monotherapy group. The triple-therapy group enjoyed a lower total number of treatments (1.92 ± 0.44 vs. 3.12 ± 0.37, p < 0.001) and a longer time before first retreatment (5.4 ± 3.3 vs. 3.6 ± 2.5 months, p = 0.001). A significant improvement of visual acuity and FT was present in both groups during the 12 months following first treatment. No adverse effects were observed. Conclusion: The combination of intravitreal bevacizumab or ranibizumabwith dexamethasone and full-fluence PDT for exudative AMD provided visual and anatomic improvement and a good safety profile. Triple therapy may reduce the number of retreatments when compared to anti-VEGF alone.

Triple Therapy for Anti-Vascular Endothelial Growth Factor Nonresponders in Neovascular Age-Related Macular Degeneration: Impact of Different Photodynamic Therapy Parameters

“…A single session of TT led to complete resolution of angiographic evidence of CNV in 77.8% of cases [10]. Forte et al [12] reviewed retrospectively the efficacy of PDT-V (50 J/cm 2 ), intravitreal dexamethasone and ranibizumab or bevacizumab in 21 eyes. They reported a significant improvement of VA and foveal thickness with a mean follow-up of 14 months.…”

“…Combination therapy with anti-VEGF agents, steroids and PDT-V has been proposed to interfere with multiple stimuli to pathologic vascular proliferation while reducing treatment frequency [8,9,10,11]. In previously published triple-therapy studies, PDT-V light fluence ranged from 25 to 50 J/cm 2 [8,9,10,11,12,13,14]. It has been shown that reducing the fluence and/or irradiance of light delivered can enhance the selectivity of PDT-V treatment, avoiding collateral damage to the physiologic choroid [15].…”

Current Strategies for the Management of Treatment-Resistant Neovascular Age-Related Macular Degeneration

“…A few other reports have suggested a possible role of dexamethasone in combination with anti-VEGF therapies [45,46]. Studies exploring the combination of verteporfin PDT, anti-VEGF and intravitreal dexamethasone failed to show superior visual outcomes when compared to anti-VEGF monotherapy [47][48][49].…”

Combined Therapies to Treat CNV in AMD: PDT + Anti-VEGF

“…A recent study (Forte et al, 2011) compared PDT + dexamethasone + anti-VEGF (Ranibizumab or Bevacizumab) triple therapy with Ranibizumab or Bevacizumab monotherapy. Sixty-one eyes were included in the first group and 40 in the second.…”