title: Quadruple therapy leads to a sustained improvement of vision in patients with wet age-related macular degeneration.
abstract: OBJECTIVE
  To investigate the efficacy of a combined intravitreal therapy with prior photodynamic therapy (PDT) in patients with wet age-related macular degeneration.
  
  
  METHODS
  Fifty-two patients (mean age: 72.7 years) with predominantly classic choroidal neovascularization received low-fluence PDT (42 J/cm2 for 72 s), followed 24 h later by a 0.4-ml core pars plana vitrectomy with intravitreal injection of dexamethasone (0.8 mg) and bevacizumab (1.25 mg). The best-corrected visual acuity (BCVA; 6 m Snellen), central macular thickness (optical coherence tomography), intraocular pressure and the need for retreatment were assessed.
  
  
  RESULTS
  BCVA changed significantly (vs. baseline) at 3 months (+0.11), 9 months (+0.19) and 14 months (+0.16). At the end of the follow-up period, BCVA had improved by > 0.1 in the majority of the patients (72.9%), and the mean central retinal thickness had decreased by -44.3% (-211 μm). The retreatment rate was 25%. No increase in intraocular pressure or other adverse event was reported.
  
  
  CONCLUSIONS
  The pharmacological effects of the drugs, the low-fluence PDT, and the physiological effects of the therapy may have contributed to the sustainability of the therapeutic benefits.
authors.affiliation: Department of Ophthalmology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. Michael.Koss@me.com
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Koss
authors.forename: Aneta
authors.initials: A
authors.lastname: Lewicka-Chomont
authors.forename: Katharina
authors.initials: K
authors.lastname: Schramm
authors.forename: Robert
authors.initials: R
authors.lastname: Rejdak
authors.forename: Christian
authors.initials: C
authors.lastname: Ohrloff
authors.forename: Frank H
authors.initials: FH
authors.lastname: Koch
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D010778:Photochemotherapy; D011166:Porphyrins / Q000009:adverse effects / Q000627:therapeutic use; D012160:Retina / Q000473:pathology; D019233:Retreatment; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D011166:Porphyrins; D000077362:Verteporfin; D000068258:Bevacizumab; D003907:Dexamethasone