#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Combined Therapy in the Exsudative Age-Related Macular Degeneration (Photodynamic Therapy and Intravitreally-Applied Ranibizumab)


Authors: J. Ernest;  L. Hejsek;  Ž. Benešová;  L. Remont;  P. Němec
Authors place of work: Oční klinika 1. LF UK a ÚVN, Praha, přednosta doc. MUDr. Jiří Pašta, CSc.
Published in the journal: Čes. a slov. Oftal., 66, 2010, No. 3, p. 119-126

Summary

The choroidal neovascularization (CNV) is the leading cause of blindness in industrial countries. CNV in age-related macular degeneration (AMRD) is dynamic, multifactor process, which cause wasn’t revealed until now. It is obvious that in multifactorial disease no single treatment is optimal, and that the monotherapy can’t cover all factors leading to the CVN development. The contemporary modern and variably effective treatment techniques have common characteristic – the treatment is very expensive and it is necessary to repeat it to obtain the treatment effect.

The authors refer about 18 months lasting period of follow-up of the group of 25 patients (9 men and 16 women, average age was 68 years, range, 59 – 76 years of age) who underwent the photodynamic therapy followed by ranibizumab intravitreal injections due to an active CNV. Mostly classical membranes were diagnosed in 18 cases (72 %), minimally classical membranes in 5 cases (20 %) and occult CNV in 2 patients (8 %). The average best corrected visual acuity before the treatment was 46 letters of EDTRS chart, and after the treatment it was 50 letters. From the total number of 25 patients, in 20 (80 %) of them the stabilization or improvement (+/- 15 letters of EDTRS chart) was achieved, in two patients the improvement was better than 15 letters (8 %). Three patients’ visual acuity decreased by more than 15 letters (12 %). On average, to stabilize the CNV (after the PDT), 3.16 applications of ranibizumab were needed.

Key words:
choroidal neovascularization, combined therapy, PDT, ranibizumab


Zdroje

1. Augustin, A., Puls, S., Offermann, I.: Triple therapy for choroidal neovascularization due to age-related macular degeneration. Retina, 27, 2007: 133–140.

2. Augustin, A., Schmidt-Erfurth, U.: Verteporfin therapy combined with intravitreal triamcinolon in all type of choroidal neovascularization due to age related macular degeneration. Ophthalmology, 113, 2006: 14–22.

3. Brown, D., Michels, M., Kaiser, P. et al.: Ranibizumab versus verteporfin photodynamic therapy for neovacular age-related macular degeneration: two years results of the ANCOR study. Ophthalmology, 116, 2009: 57–65.

4. Costa,R., Horte, R., Calucci, D. et al.: Intravitreal bevacizumab (Avastin) in combination with verteporfin photodynamic therapy for choroidal neovascularization associated with age-related macular degeneration (Ibere Study). Grafes Arch. Clin. Exp. Ophthalmol., 245, 2007: 1273-1280.

5. Dhala, M., Shah, G., Binder, K. et al.: Combined photodynamic therapy with verteporfin and intravitrel bevacizumab for choroidal neovacularization in age-related macular degeneration. Retina, 26, 2006: 988–993.

6. Ferrari, N.: Vascular endothelial growth factor: basic science and clinical progress. Endocrine Reviews, 25, 2004: 581-611.

7. Gragoudas, E., Adami, A., Cunningham, E. et al.: VEGF Inhibition Study in Ocular Neovascularization Clinical Trial Group. Pegatanib for neovascular age-related macular degeneration. N. Engl. J. Med., 351, 2004: 2805–2816.

8. Heier, J., Boyer, D., Ciulla, T. et al.: Ranibizumab combined with verteporfin photodynamic therapy in age-related macular degeneration. Year 1 results Focus study. Arch. Ophthalmol., 124, 2006: 1532–1542.

9. Husai, D., Kim, I., Ganthier, D. et al.: Safety and efficacy of intravitreal injection of ranibizumab in combination with verteporfin PDT on experimental choroidal neovascularization in the monkey. Arch. Ophthalmol., 123, 2005: 509–516.

10. Kaiser, P.: Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: 5-year results of two randomized clinical trial with open-label extension: TAP report No. 8. Graefes Arch. Clin. Exp. Ophthalmol., 244, 2006: 1132–1142.

11. Kaiser, P.: Verteporfin photodynamic therapy combined with intravitreal bevacizumab for neovascular age-related macular degeneration. Ophthalmology, 116, 2009: 747-755.

12. Kaiser, P.: Verteporfin therapy in combination with triamcinolone:publishd studies investigating a potential synergetic effect. Curr. Med. Res. Opin., 21, 2005: 705–713.

13. Kamer, M., Miller, J., Michaud, N. et al.: Liposomal benzoporphyrin derivate verteporfin photodynamic therapy. Selective treatment of choroidal neovacularization in monkeys. Ophthalmology, 103, 1996: 427–438.

14. Kent, D., Sheridan, C.: Choroidal neovascularization: a wound healing prospective. Mol. Vis., 9, 2003: 747–755.

15. Ladewig, M., Karl, S., Hamelmann, V. et al.: Combined intravitreal bevacizumab and photodynamic therapy for neovacular age-related macular degeneration. Graefes Arch. Clin. Exp. Ophthalmol., 246, 2008: 17–25.

16. Lazic, R., Gabric, N.: Verteporfin therapy and intravitreal bavacizumab combined and alone in choroidal neovascularization due to age-related macular degeneration. Ophthalmology, 114, 2007: 1179–1185.

17. Polito, A., Idoly, M., Lanzetta, C. et al.: The natural history of occult choroidal neovascularization associated with age related macular degeneration: systemic review. An. Acad. Med. Singapure, 35, 2006: 145-50.

18. Rechtman, E., Danis, R., Pratt, L. et al.: Intravitreal triamcinolon with photodynamic therapy for subfoveal choroidal neovascularization in age related macular degeneration. Br. J. Ophthalmol., 88, 2004: 344–347.

19. Regillo, C., Brown, D., Abraham, P. et al.: Randomized,double-masket,sham-controlled trial of ranibizumab for neovascular age-related macula degeneration: PIER study year. Am. J. Ophthalmol., 145, 2008: 239–247.

20. Schmidt-Erfurth, U., Laqua, H., Schlotzer-Schrehard, U. et al.: Histopathological changes following photodynamic therapy in human eyes. Arch. Ophthalmol., 120, 2002: 835–844.

21. Schmidt-Erfurth, U., Miller, J., Sichenberg, M. et al.: Photodynamic therapy with verteporfin for choroidal neovascularization caused by age related macular degeneration: results of retreatments in phase 1 and 2 study. Arch. Ophthalmol., 117, 1999: 1177–1187.

22. Schmidt-Erfurth, U., Scholter-Schrehard, U., Cursiefen, C. et al.: Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF) VEGF receptor 3 and pigment epithelium-derived factor. Incest. Ophthalmol. Vis. Sci., 44, 2003: 4473–4480.

23. Spaide, R.: Perspectives. Rationale for combination therapies for choroidal neovascularization. Am. J. Ophthalmol., 141, 2006: 149–156.

24. Spaide, R.: Rationale for combination therapy in age-related macular degeneration. Retina, 29, 2009: 2–4.

25. Souček, P., Cihelková I.: Fotodynamická terapie s verteporfinem v éře anti-VEGF. Farmakoterapie, 3, 2007, 5: 523–527.

26. Treatment of Age-Related macular degeneration with Photodynamic Therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macula degeneration with verteporfin: two year results of 2 randomized clinical trials-TAP report 2. Arch. Ophthalmol., 119, 2001: 198–207.

27. Verteporfin in Photodynamic Therapy Study Group. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macula degeneration: two year results of randomized clinical trial including lesions with occult with no classic choroidal neovascularization. Verteporfin in Photodynamic Therapy report 2. Am. J. Ophthalmol., 131, 2001: 541–560.

Štítky
Ophthalmology

Článok vyšiel v časopise

Czech and Slovak Ophthalmology

Číslo 3

2010 Číslo 3

Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#