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Intravitreales Bevacizumab vs. Verteporfin und intravitreales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD

Intravitreal bevacizumab versus verteporfin and intravitreal triamcinolone acetonide in patients with neovascular age-related macula degeneration

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Zusammenfassung

Ziel

Vergleich von intravitrealer Bevacizumab (IVB)- und Verteporfin-Therapie in Kombination mit 4 mg intravitrealem Triamcinolon (PDT-IVTA) bei Patienten mit neovaskulärer altersbezogener Makuladegeneration (AMD).

Patienten und Methoden

In einer prospektiven, randomisierten Studie wurden 30 Augen von 30 Patienten mit neovaskulärer AMD inkludiert. Zehn Augen wurden mit PDT-IVTA mit Standard-Lichtdosis (SPDT-IVTA) von 50 J/cm2, 10 Augen mit PDT-IVTA reduzierter Lichtdosis von 25 J/cm2 (RPDT-IVTA) und weitere 10 Augen mit 1 mg IVB behandelt. Der Therapieeffekt wurde mittels Early Treatment Diabetic Retinopathy Study (ETDRS) Visus, Fluoreszenzangiographie und optischer Kohärenztomographie (OCT) vor und 1 Tag, 1 Woche, 1 und 3 Monate nach Behandlungsbeginn evaluiert.

Ergebnisse

Vor Behandlungsbeginn zeigte sich eine insgesamt ausgeglichene Gruppenverteilung. Nach 3 Monaten kam es bei der SPDT-IVTA-Gruppe zu einem nichtsignifikanten Visusverlust von 7 Buchstaben (p<0,3), und in der RPDT-IVTA-Gruppe zu einem Visusverlust von 0,5 Buchstaben (p<0,9). Zum gleichen Zeitpunkt betrug der Visusgewinn in der IVB-Gruppe 11,8 Buchstaben (p<0,001). Der Visusgewinn in der IVB-Gruppe war statistisch signifikant im Vergleich zu den Visusergebnissen beider PDT-IVTA-Gruppen (p<0,05). Die zentrale Netzhautdicke (CRT) nahm bis zum Monat 3 in der SPDT-IVTA-Gruppe um 132 μm, in der RPDT-IVTA-Gruppe um 78 μm und in der IVB-Gruppe um 138 μm ab, (p<0,05 in 3 Gruppen). Nach 3 Monaten fand sich kein signifikanter Unterschied der Netzhautdickenabnahme zwischen den Behandlungsgruppen.

Schlussfolgerung

Im Kurzzeitverlauf zeigt IVB gegenüber beiden PDT-IVTA-Gruppen signifikant bessere Visusergebnisse. Innerhalb von 3 Monaten fand sich in allen Gruppen eine vergleichbare Abnahme der CRT. Langzeitbeobachtungen sind erforderlich, um die Sicherheit und Wirksamkeit der Therapieformen zu beurteilen.

Abstract

Aim

The aim of this study was to compare intravitreal bevacizumab (IVB) and verteporfin therapy in combination with 4 mg intravitreal triamcinolone (PDT-IVTA) in patients with neovascular age-related macular degeneration (AMD).

Patients and methods

A total of 30 eyes of 30 patients with neovascular AMD were included in a prospective, randomized study. Ten eyes received PDT-IVTA with a standard light fluence of 50 J/cm2 (SPDT-IVTA), ten were treated with PDT-IVTA with a reduced light fluence of 25 J/cm2 (RPDT-IVTA) and ten received IVB. The main outcome was evaluated using early treatment diabetic retinopathy study (ETDRS) visual acuity, fluorescein angiography and optical coherence tomography (OCT) at baseline as well as at day 1, week 1, 1 month and 3 months after therapy.

Results

At the beginning of therapy, the distribution of the groups was balanced. After 3 months, the SPDT-IVTA group showed a non-significant vision loss of seven letters (p<0.3) while a vision loss of 0.5 letters (p<0.9) was found in the RPDT-IVTA group. At the same time, the IVB group had a vision improvement of 11.8 letters (p<0.001). This vision improvement was statistically significant compared to the results of both PDT-IVTA groups (p<0.005). Central retinal thickness (CRT) decreased up to month 3 in the SPDT-IVTA group by 132 μm, in the RPDT-IVTA group by 78 μm and in the IVB group by 138 μm, (p<0.05 in the three groups). No significant difference in the decrease of CRT was found between the treatment groups after 3 months.

Conclusion

IVB shows significantly better results in vision improvement in the short-term compared to the two PDT-IVTA groups. Within 3 months, all groups showed a comparable decrease in CRT. Long-term follow-up is required to evaluate the safety and treatment efficacy of all treatment modalities.

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Authors and Affiliations

  1. Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Währinger Gürtel 18–20, Wien, Österreich

    R. Hahn, S. Sacu, S. Michels, A. Varga, G. Weigert, W. Geitzenauer, P. Vécsei-Marlovits & U. Schmidt-Erfurth

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  1. R. Hahn
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  2. S. Sacu
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  3. S. Michels
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  4. A. Varga
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  5. G. Weigert
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  6. W. Geitzenauer
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  7. P. Vécsei-Marlovits
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  8. U. Schmidt-Erfurth
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Correspondence to S. Sacu.

Additional information

Der Beitrag wurde auf der 104. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft im Jahr 2006 in Berlin vorgetragen.

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Hahn, R., Sacu, S., Michels, S. et al. Intravitreales Bevacizumab vs. Verteporfin und intravitreales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD. Ophthalmologe 104, 588–593 (2007). https://doi.org/10.1007/s00347-007-1547-4

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