Comparison of single photodynamic therapy with triple combined therapy for age-related macular degeneration

Purpose: To compare the effectiveness of photodynamic theraphy (PDT) and PDT combined with intravitreal triamcinolone (IVTA) and vascular endothelial growth factor inhibition (anti-VEGF) in age-related macular degeneration (AMD)Method: 80 eyes of 80 patients diagnosed with choroidal neovascularization (CNV) caused by AMD between January 2005 - July 2008 were included the study. The patients divided groups according to the treatment modality. PDT was carried out in 40 eyes in group I, PDT combined 4 mg IVTA and anti-VEGF (1.25mg bevacizumab in 20 eyes, 0.3mg pegabtanib sodium in 20 eyes) in group II. Approximately 4-5 days after İVTA injection PDT, and after 45 minutes intravitreal anti-VEGF injection was applied. All patients completed 1st, 3rd and 6th month visits in both groups. 8 patients in group I, 15 patients in group II were not complete 12 month follow up. For this reason, there was 32 patients in group I, 25 patients in group II at 12th month evaluation. Ophthalmic examination was carried out pre and post treatment, fluorescein angiography (FA) and optical cohorence tomography (OCT) were applied to all patients.Results: Mean follow-up was 11.93±0,99 months in group I and 10.90±1,58 months in group II. Pretreatment best corrected visual acuity (BCVA) in group I ve group II was 0.95±0.34 logMAR and 0.90±0.43 logMAR respectively. In 12th months 1.24±0.42 logMAR and 0.71±0.09 logMAR respectively (p<0.05). In group I there was 2.88 logMAR line decrease in vision between pretreatment and 12th month measurements, 1.95 logMAR line increase was found in group II (p<0.05). Decrease in vision less than 3 lines in group I and group II was %67.5 and %87.5 in 6th months and %56.3 and %80 in 12th months (p>0.05), respectively. Increase in vision 3 lines and more in group I and group II was %6,3 and %32 in 12th months (p<0.05), respectively. In 12th months according to pretreatment measurements central foveal thickness was decreased 50 ?m in group I and 125 ?m group II. In 12 months, mean PDT sessions number was 2.00 in group I, the mean combined treatment sessions number was 1.15 in group II. Anti-VEGF or anti-VEGF + IVTA injection were applied 13 eyes (%32.5) in group II. In group II %12.5 patiens were developed glaucoma and %16.1 had cataract progression.Conclusion: Combination of IVTA and anti-VEGF to PDT is more effective and safer than PDT monotheraphy in the treatment of CNV secondary to AMD. Combination treatment decrease the frequency and number of treatment sessions for a improved visual prognosis.