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Triple therapy for Neovascular Age-related macular degeneration using single session Photodynamic therapy combined with intravitreal Bevacizumab and Triamcinolone
  1. Pui Pui Yip (terriyip2000{at}yahoo.com.hk),
  2. Chai Fong Woo,
  3. Hoi Yau Tang (tanghoiyau{at}gmail.com),
  4. Chi Kin Ho
  1. Department of Ophthalmology, Tuen Mun Hosptial, Hong Kong
  2. The Hong Kong Ophthalmic Associates, Hong Kong
  3. Department of Ophthalmology, Tuen Mun Hosptial, Hong Kong
  4. Department of Ophthalmology, Tuen Mun Hosptial, Hong Kong

    Abstract

    Purpose: To evaluate the efficacy and safety of triple therapy consisting single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVTA) for treatment of neovascular age-related macular degeneration (AMD).

    Methods: Consecutive patients with subfoveal choroidal neovascularization (CNV) secondary to AMD were treated with PDT,IVB and IVTA. IVB was given at 3 month for residual leakage. Best corrected Snellen visual acuity (BCVA) and fluorescein angiography (FA) were performed prior to treatment. BCVA, intraocular pressure (IOP), presence of vitritis were documented at 1 and 6 weeks, 3 and 6 months. FA was repeated at 3 and 6 months. Outcome measures included visual improvement measured by logMAR equivalent, angiographic evident of leakage and safety profile.

    Results: 36 eyes of 33 patients, aged 76.4+/-10.5 years with mean follow up of 14.7 (6.9-19.2) months were analyzed. Baseline logMAR acuity was 1.22+/-0.71. Mean logMAR acuity was 1.14+/-0.62 and 1.18+/- 0.63 at 3 and 6 months respectively. At 6 months, 61.1% got stable or gaining vision and 27.8% gained 3 or more lines. Twenty-eight eyes (77.8%) achieved CNV resolution by single session of triple therapy. One eye lost more than 6 lines, 3 eyes got significant cataract requiring surgery and 2 got persistent raised IOP at 6 months. None resulted in endophthalmitis or reported thrombo-embolic event.

    Conclusions: Short term results of single session triple therapy suggested that it might be a useful treatment option for neovascular AMD. However, risk and benefits of using IVTA in addition to combined PDT and IVB warrant further evaluation.

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