title: Single-session photodynamic therapy combined with intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration.
abstract: BACKGROUND
  To evaluate the efficacy of triple therapy consisting of single-session photodynamic therapy (PDT), intravitreal bevacizumab (IVB) and intravitreal triamcinolone (IVT) as initial pulse therapy followed by repeat intravitreal bevacizumab injections for maintenance treatment in neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) secondary to AMD underwent pulse therapy with single-session PDT according to the standard protocol followed by 1.25 mg IVB and 2 mg IVT 48 hours later. Best corrected visual acuity (BCVA) was assessed and optical coherence tomography (OCT) and fluorescein angiography (FA) were performed prior to treatment. BCVA and OCT measurements were repeated at 6 week intervals and FA was obtained after 12 weeks and when necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage.
  
  
  RESULTS
  This series included 17 eyes of 17 patients with mean age of 67.6 +/- 7.2 years. Mean follow up duration was 50.4 +/- 15.5 weeks. Mean BCVA prior to treatment was 0.74 +/- 0.33 logMAR which improved to 0.52 +/- 0.36 logMAR after 12 weeks (P = 0.012) and 0.41 +/- 0.38 logMAR after 24 weeks (P = 0.001). Mean pretreatment central macular thickness (CMT) was 395 +/- 181 micro which was significantly reduced to 217 +/- 69 micro (P = 0.005), 231 +/- 79 micro (P = 0.028) and 221 +/- 87 micro (P = 0.05) six, twelve and twenty-four weeks after initial treatment respectively. Visual acuity improvement and CMT reduction was maintained during the follow-up period. IVB injections were repeated once, twice and three times in 10, 7 and 2 eyes at a mean interval of 20.2 +/- 10.1, 19 +/- 13.7 and 15 +/- 1.4 weeks after initial therapy, respectively.
  
  
  CONCLUSIONS
  Initial pulse triple therapy consisting of single-session PDT combined with IVB and IVT improves vision and reduces CMT in neovascular AMD. Repeat IVB injections maintain the visual gain from the initial combination therapy.
authors.affiliation: Ophthalmic Research Center, Shaheed Beheshti Medical University, Labbafinejad Medical Center, Tehran, Iran. hahmadieh@hotmail.com
authors.forename: Hamid
authors.initials: H
authors.lastname: Ahmadieh
authors.forename: Ramin
authors.initials: R
authors.lastname: Taei
authors.forename: Masoud
authors.initials: M
authors.lastname: Soheilian
authors.forename: Mohammad
authors.initials: M
authors.lastname: Riazi-Esfahani
authors.forename: Reza
authors.initials: R
authors.lastname: Karkhaneh
authors.forename: Alireza
authors.initials: A
authors.lastname: Lashay
authors.forename: Mohsen
authors.initials: M
authors.lastname: Azarmina
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Dehghan
authors.forename: Siamak
authors.initials: S
authors.lastname: Moradian
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D011446:Prospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage* / Q000627:therapeutic use; D014792:Visual Acuity / Q000187:drug effects; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D014221:Triamcinolone; D000068258:Bevacizumab