Combined therapy in exudative age-related macular degeneration.
OBJECTIVE
Therapeutic options in active exudative age-related macular degeneration (AMD) are following means used to destroy the choroidal neovascularization (CNV) lesion: laser photocoagulation, radiotherapy, transpupillary thermotherapy, photodynamic therapy (POT) or removal of neovascular membrane through vitreoretinal surgery. Another possibility is to suppress the development of neovasculanization through intravitreal administration of anti-VEGF agents: ranibizumab, bevacizumab (off-label), sodium pegaptanib or steroids (off-label). The aim of this paper is to present the early phase of treating exudative AMO with combined therapy: photodynamic therapy with intravitreal ranibizumab injection.


METHODS
Our observation is based on three clinical cases. Observations are being carried out on larger patient groups according to the treatment scheme presented in this paper.


RESULTS
In the three cases described one POT procedure and the saturation phase of three ranibizumab injections allowed a significant improvement in visual acuity and closure of CNV leakage confirmed by fluorescein angiography (FA) and optical coherence tomography (OCT). Treatment is being continued according to AMO activity: next POT in case of leakage in FA, another ranibizumab injection according to PRONTO study reinjection criteria.


CONCLUSIONS
The pathomechanism of exudative AMB confirms reasonability of combined treatment. Considering the stages of neovascularization in exudative AMO. VEGF inhibition combined with POT has a synergistic action and increases the effectiveness of both therapies alone. L.arge clinical studies (FOCUS) show that combined therapy reduces the number or required POT procedures. In combined therapy modification of POT parameters should be considered: reduction of energy and laser exposure time.
Department of Ophthalmology, Military Health Service Institute, Warsaw. malgorzata-figurska@wp.pl
Małgorzata
M
Figurska
Joanna
J
Wierzbowska
Jacek
J
Robaszkiewicz
D000368:Aged; D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D010778:Photochemotherapy / Q000379:methods; D011244:Pregnadienediols / Q000627:therapeutic use; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields; D014821:Vitrectomy / Q000379:methods
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D011244:Pregnadienediols