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Anales de la Sociedad Mexicana de Oftalmología y Archivos de la Asociación Para Evitar la Ceguera en México

2018, Number 4

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Rev Mex Oftalmol 2018; 92 (4)

Photodynamic therapy combined with intravitreal bevacizumab for the management of choroidal neovascularization resistant to bevacizumab monotherapy. A case series

García-Aguirre G, Romo-Aguas JC, Santos-Palacios A, Henaine-Berra A, Vélez-Montoya R, Fromow-Guerra J

Language: Spanish
References: 25
Page: 180-186
PDF size: 461.34 Kb.


ABSTRACT

Purpose: To evaluate the clinical response of treatment-resistant choroidal neovascularization (CNV) to photodynamic therapy (PDT) combined with bevacizumab (BVZ) therapy. Methods: Retrospective, non-comparative evaluation of eyes diagnosed with CNV secondary to age-related macular degeneration that had no response after at least 3 intravitreal BVZ injections, who were treated with combined PDT+BVZ therapy, followed by subsequent monthly BVZ for a 6-month period. Main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a 6 month follow-up period after combined therapy. Results: Eleven patients (54.5% female, mean age 62 years) were included. Using ICG angiography, lesions were classified as polypoidal choroidal vasculopathy (PCV) in 54.5%, arteriolized CNV in 18.2% (2), and non-differentiable in 27.3% (3). BCVA (logMAR) at baseline was 0.63 (20/85), increasing to 0.32 (20/40) 6 months after treatment (p = 0.04). Mean CMT before the intervention was 469 µm, decreasing to 289 µm 6 months after treatment (p = 0.01). Conclusion: Combined PDT+BVZ therapy appears to be effective in treatment-resistant CNV, with an improvement of BCVA and CMT after a 6-month period that was not observed with BVZ monotherapy. A high incidence of PCV and arteriolized CNV or treatment-resistant CNV cases was observed in this group. The correct classification of highly resistant CNV types may be useful for treatment.


REFERENCES

  1. Brucker AJ. Age-related macular degeneration. Retina. 2009;29:S2-4.

  2. Arevalo JF, Lasave AF, Wu L, et al. Intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration: 5-year Results of the pan-American collaborative retina study group. Retina. 2016;36:859-67.

  3. Date A, Koreen L, Hollar MW, Cousins SW. Where do PCV and RAP Fit in the Spectrum of AMD CNV Subtypes? Subtypes: beyond classic and occult. Retin Phys. 2010:1-9.

  4. Koh A, Lee WK, Chen LJ, et al. Everest study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012;32:1453-64.

  5. Stone TW, editor. ASRS 2016 Preferences and Trends Membership Survey. Chicago, IL. American Society of Retina Specialists; 2016.

  6. Tozer K, Roller AB, Chong LP, et al. Combination therapy for neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor agents. Ophthalmology. 2013;120:2029-34.

  7. Antoszyk AN, Tuomi L, Chung CY, et al. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results. Am J Ophthalmol. 2008;145:862-74.

  8. Williams PD, Callanan D, Solley W, Avery RL, Pieramici DJ, Aaberg T. A prospective pilot study comparing combined intravitreal ranibizumab and half-fluence photodynamic therapy with ranibizumab monotherapy in the treatment of neovascular age-related macular degeneration. Clin Ophthalmol. 2012;6:1519-25.

  9. Amoaku WM, Chakravarthy U, Gale R, et al. Defining response to anti- VEGF therapies in neovascular AMD. Eye. 2015;29:721-31.

  10. Lux A, Llacer H, Heussen FM, Joussen AM. Non-responders to bevacizumab (Avastin) therapy of choroidal neovascular lesions. Br J Ophthalmol. 2007;91:1318-22.

  11. Tan CS, Ngo WK, Chen JP, Tan NW, Lim TH. Everest study report 2: imaging and grading protocol, and baseline characteristics of a randomised controlled trial of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2015;99:624-8.

  12. Stoller GL, Kokame GT, Dreyer RF, Shapiro H, Tuomi LL. Patterns of early and delayed visual response to ranibizumab treatment for neovascular age-related macular degeneration. JAMA Ophthalmol. 2016;134:545-53.

  13. Schmidt-erfurth U, Michels S, Barbazetto I, Laqua H. Photodynamic effects on choroidal neovascularization and physiological choroid and physiological choroid. Invest Ophthalmol Vis Sci. 2016;43:830-41.

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

  15. Brown DM, Michels M, Kaiser PK, et al. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology. 2009;116:57-65.

  16. Antoszyk AN, Tuomi L, Chung CY, Singh A, FOCUS Study Group. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration (FOCUS): year 2 results. Am J Ophthalmol. 2008;145:862-74.

  17. Bashshur ZF, Schakal AR, El-Mollayess GM, Arafat S, Jaafar D, Salti HI. Ranibizumab monotherapy versus single-session verteporfin photodynamic therapy combined with as-needed ranibizumab treatment for the management of neovascular age-related macular degeneration. Retina. 2011;31:636-44.

  18. Krebs I, Marlovits VV, Bodenstorfer J, et al. Comparison of ranibizumab monotherapy versus combination of ranibizumab with photodynamic therapy with neovascular age-related macular degeneration. Acta Ophthalmol. 2013;91:178-83.

  19. Hatz K, Schneider U, Henrich PB, Braun B, Sacu S, Prünte C. Ranibizumab plus verteporfin photodynamic therapy in neovascular age-related macular degeneration: 12 months of retreatment and vision outcomes from a randomized study. Ophthalmologica. 2015;233:66-73.

  20. Larsen M, Schmidt-Erfurth U, Lanzetta P, et al. Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration: twelve-month MONT BLANC study results. Ophthalmology. 2012;119:992-1000.

  21. Kaiser PK, Boyer DS, Cruess AF, et al. Verteporfin plus ranibizumab for choroidal neovascularization in age-related macular degeneration: twelve- month results of the DENALI study. Ophthalmology. 2012;119:1001-10.

  22. Bakri SJ, Couch SM, McCannel CA, Edwards AO. Same-day triple therapy with photodynamic therapy, intravitreal dexamethasone, and bevacizumab in wet age-related macular degeneration. Retina. 2009;29:573-8.

  23. Kloos P, Niederberger H, Valmaggia C. Photodynamic therapy in “secondary sick RPE syndrome” after repeated intravitreal injections of VEGF inhibitors in patients with wet age-related macular degeneration [In German]. Klin Monbl Augenheilkd. 2011;228:340-4.

  24. Cho M, Barbazetto IA, Freund KB. Refractory neovascular age-related macular degeneration secondary to polypoidal choroidal vasculopathy. Am J Ophthalmol. 2009;148:70-78.

  25. Koh A, Lai TY, Takahashi K, et al. Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: a Randomized clinical trial. JAMA Ophthalmol. 2017;135:1206-13.




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